Bone surgery

What is subacromial shoulder surgery?

Recent research published in the Lancet in November 2017*, testing the effectiveness of subacromial shoulder surgery compared to placebo surgery or no treatment, has brought into question whether subacromial shoulder surgery is an effective treatment. If you are considering subacromial shoulder surgery this site provides information and patient experiences on this type of surgery.
 
A shoulder is a ball and socket joint. The joint is surrounded by a deep layer of tendons called the rotator cuff. When the arm is lifted up to the side or in front of the body, these rotator cuff tendons pass underneath the bony roof of the shoulder. These tendons can rub on this bony roof and sometimes a bony spur develops. This rubbing results in pain felt over the shoulder and the side of the upper arm. The tendon can become thickened, painful and worn, and may even tear. This rubbing of the tendon can settle with time, rest, physiotherapy and a cortisone injection. If the symptoms persist, though, day case surgery called arthroscopic subacromial decompression (ASD) may be needed. Subacromial shoulder surgery is carried out by an orthopaedic shoulder surgeon (a doctor who specialises in bone surgery of the shoulder). The surgery usually takes no more than half an hour. Once the anaesthetic has taken effect, the surgeon will usually make two small keyhole cuts in the skin around the shoulder. He or she will look inside the shoulder joint with a small keyhole camera and insert specially designed keyhole surgical instruments through the small cuts and shave off a bony spur from the roof of the shoulder (acromion). The surgeon may also decide to repair any damaged tendons at the same time which then makes the operation and the recovery longer. This may mean that the surgeon has to change from keyhole surgery to an open operation and will make a small open cut over the top of the shoulder. At the end of the operation, the surgeon will remove the surgical instruments and close the cuts with sticky dressings or stitches.
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As with every operation, there are some risks associated with subacromial decompression but these are very rare. The chance of infection is small, with most surgeons quoting an infection risk of 1 in 200 or 1 in 300 people (Professor Jonathan Rees 2015). There is a higher chance (5%) of getting a stiffness problem called frozen shoulder, which can take several months to resolve*. The risks to nerves are extremely rare with this type of surgery.**
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It usually takes between two and six months to make a full recovery from subacromial decompression but it can take longer. How long it takes to recover depends on a number of things, including how healthy a person is before the operation and how well they keep up with the physiotherapy [exercises] after the operation.
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See our resources for more information.

*Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial, Prof David J Beard, DPhil; Prof Jonathan L Rees, FRCS; Jonathan A Cook, PhD; Ines Rombach, MSc ; Cushla Cooper, MSc ; Naomi Merritt, BSc ; et al. Published: November 20, 2017 DOI:https://doi.org/10.1016/S0140-6736(17)32457-1
**Yeranosian MG, Arshi A, Terrell RD, Wang JC, McAllister DR, Petrigliano FA. Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery. American Journal of Sports Medicine. 2014 Feb;42(2):437-41

Last reviewed November 2018.
Last updated November 2018.
Donate to healthtalk.org​ • *Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial, Prof David J Beard, DPhil; Prof Jonathan L Rees, FRCS; Jonathan A Cook, PhD; Ines Rombach, MSc ; Cushla Cooper, MSc ; Naomi Merritt, BSc ; et al. Published: November 20, 2017 DOI:https://doi.org/10.1016/S0140-6736(17)32457-1

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