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Arthroscopic Subacromial Decompression

Arthroscopic Subacromial Decompression is a relatively non-invasive procedure for the treatment of Subacromial Impingement Syndrome.

Shoulder surgery has changed dramatically over the past decade.  With the introduction of arthroscopic surgical techniques for shoulder pathology, minimal pain and rapid recovery have become the major benefits.

Some conditions which have been successfully treated are:

  • Labral Tears
  • Shoulder Instability
  • Adhesive Capsulitis
  • Subacromial Impingement

Subacromial Impingement is a condition where the rotator cuff  tendon is pinched between the humeral head and the undersurface of the acromion.  There are various causes for this condition (see Subacromial Impingement Syndrome).  Howevever, if after a course of conservative treatment, consisting of anti-inflammatory medication and physical therapy, your symptoms do not improve, Arthroscopic Subacromial Decompression  may be the next step in your treatment.

Arthroscopic subacromial decompression is most commonly performed on an out-patient basis.  Depending on the patient's medical condition, and with the input of the anesthesiologist, a general anesthetic, or shoulder block (local anesthesia) will be employed to control pain during the procedure.  Prior to your surgery, pre-operative blood testing will be obtained.  Depending on your general condition, a medical clearance may be required from your internist or family physician. In addition, approximately one week prior to surgery, all anti-inflammatory medications (such as aspirin, motrin, etc.) should be discontinued in order to reduce bleeding during surgery.

A number of small incisions will be made around the shoulder to gain entry into the joint.  Utilizing an arthroscope and video camera, the doctor visualizes the structures inside the shoulder and confirms the diagnosis of subacromial impingement.  One of the added benefits of direct visualization of the shoulder joint is that any unexpected pathology can be identified and dealt with at the time of surgery.

After the diagnostic portion of the surgery is completed, a number of highly specialized "micro motorized" instruments are inserted into the subacromial space and the bone from the underside of the acromion is removed.  The bone removal is completed when the tendons of the rotator cuff are free to glide between the humeral head and the acromion without pinching or catching on the bone.

When the arthroscopic procedure is completed, the surgical incisions are closed with a single suture.  A dressing and sling are applied and the patient is sent to the recovery room.  Discharge home is usually within an hour or two.  The patient receives instructions regarding care of the surgical site, and a prescription for pain medication.

Most patients will find that only mild analgesics will be necessary to control their pain.  If you experience a temperature above 100 degrees, pain that is not controlled by the prescribed medication, or tingling and numbness in the arm or hand, be sure to contact your doctor.

You will be seen back in the office within a day or two of your surgical procedure.  At that time the dressing will be removed and the incisions will be covered with "band-aids".  You will be given a prescription to start physical therapy.  As in the non-operative management of subacromial impingement syndrome, physical therapy is the mainstay of treatment to achieve as complete a recovery as possible.  Patients should not be discouraged if the pre-operative pain does not improve right away.  The symptoms may take up to three months to resolve, at which time the full benefits of surgery are noted.  However, the majority of patients see a dramatic and rapid improvement of their symptoms soon after surgery.

Arthroscopic subacromial decompression is a minimally invasive surgical procedure performed on an out-patient basis.  It results in minimal to no scaring, little if any pain, and rapid return of function.


 

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