As the population ages, more people will experience pain from shoulder impingement. The American Academy of Orthopaedic Surgeons reports shoulder bursitis and rotator cuff tendinitis increase with age. Shoulder impingement can cause irritation of the bursa or partial rotator cuff tears. When shoulder symptoms do not improve with therapy and medications, then surgery is undertaken to open up space around the rotator cuff. Complications during and after surgery are rare.
Surgery
Over the past two decades, arthroscopic shoulder surgery has become more common than open shoulder surgery for shoulder impingement. During arthroscopic surgery, three small incisions are made on the shoulder. Open surgery is done through a 3- to 4-inch incision on the shoulder. Bursa is removed. Bone from the acromion and sometimes the clavicle is removed. Before or after the procedure, the shoulder may be numbed by an anesthetic injected into the nerves in the neck.
Anesthesia
There are risks of general anesthesia and nerve anesthetics. Duke University's Wheeless Textbook of Orthopaedics lists air embolism, stroke and death as shoulder surgery risks. Nerves that pass near the shoulder may also be damaged, resulting in numbness or muscle weakness.
Infection
Another dreaded complication of shoulder surgery is infection. Prolonged antibiotics may be needed to treat the infection. The wounds can come open. The American Academy of Orthopaedic Surgeons indicates this occurs in less than 1 percent of surgeries.
Loss of Motion
According to the American Academy of Orthopaedic Surgeons, two types of inflammatory reactions can begin in the shoulder after surgery. Extra bone may be produced. The extra bone, heterotopic ossification, may produce pain. The shoulder joint can become inflamed. The joint capsule thickens, resulting in a painful loss of motion. AAOS notes this condition, called adhesive capsulits, occurs in less than 1 percent of surgeries.
Instability
Patients may also experience increased motion of their collarbones. AAOS reviewed data showing the increased motion of the clavicle is usually related to excessive resection of the clavicle or ligaments.
Fracture
In the 1994 "Journal of Shoulder and Elbow Surgery," Dr. Leslie Matthews discussed acromial fractures occurring after shoulder impingement surgery. In the "Malaysian Orthopaedic Journal," there was a report of clavicle fracture after shoulder impingement surgery. Patients with a fracture noted increasing pain after surgery. The pain may begin suddenly after a minor fall or therapy. Healing of the fractures may be slow or not occur.
Outcome
Surgical complications are rare after shoulder impingement surgery, but there are several serious complications that can happen. AAOS recommends conservative treatment of shoulder impingement be tried before surgery.
References
- "Comprehensive Orthopaedic Review"; J. Lieberman, editor; 2009
- Duke Orthopaedics: Arthroscopy of the Shoulder Joint
- American Academy of Orthopaedic Surgeons: Your Orthopaedic Connection: Rotator Cuff Tears and Treatment Options
- Malaysian Orthopaedic Journal: Pathological Fracture of Clavicle Following Sub-Acromial Decompression-Infraclavicular Compartment Syndrome?
- "Journal of Shoulder and Elbow Surgery"; Acromial fracture: A Complication of Arthroscopic Subacromial Decompression; Leslie S. Matthews, W.Z. Burkhead, Stuart Gordon, John Racanelli, Louis Ruland; 1994
