Patients who struggle with chronic symptoms related to subacromial impingement may be candidates for arthroscopic subacromial decompression. While most cases of impingement syndrome are largely related to poor coordination in the movement of the upper arm and shoulder blade and respond favorably to a dedicated physical therapy program, there are cases where the subacromial space is excessively tight due to the development of bone spurs or other factors in a patient’s anatomy.
In these cases the excessive bone is gently removed arthroscopically with the assistance of video technology through small incisions using a motorized device that smooths the undersurface of the acromion in what is called and acromioplasty. Thickened bursa material that has formed over time from ongoing bursitis is also removed and the entire process opens up the space between the top of the humerus and the underside of the acromion thus “decompressing” the rotator cuff.
The recovery from decompression surgery is generally accelerated as there is no structural repair of damaged material that requires protection in order to heal. A brief period of time in a sling for comfort is recommended followed by a rapid transition to a physical therapy program geared toward optimizing the mechanics of the upper arm and shoulder blade movements.
Pain management following subacromial decompression involves the use appropriate pain medication and liberal use of ice. Frequent icing has been shown to have a profound effect on postoperative pain. We also utilize nerve blocks in almost all rotator cuff surgeries. The block, administered by an anesthesiologist just prior to surgery, uses a long acting numbing agent which affords the patient complete relief of shoulder pain for many hours following surgery. As the block begins to wear off patients are able to anticipate the pain that will follow and start treating it with their prescribed medication before the pain starts.