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Arthroscopic Subacromial Decompression
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is Arthroscopic Subacromial Decompression?
Arthroscopic Subacromial Decompression is a surgical procedure aimed at relieving pain and restoring function in the shoulder, particularly in cases involving impingement syndrome. This procedure is performed using arthroscopy, a minimally invasive technique that involves inserting a small camera and instruments through tiny incisions around the shoulder.
Arthroscopic Subacromial Decompression is typically recommended when conservative treatments, like physical therapy and medication, have not provided sufficient relief.
When is Arthroscopic Subacromial Decompression Needed?
Arthroscopic Subacromial Decompression is primarily indicated for patients suffering from subacromial impingement syndrome, a condition characterised by pain and limited movement in the shoulder. This typically arises from the compression of the rotator cuff tendons and the subacromial bursa within this space.
The need for this surgical intervention is considered under the following circumstances:
- Persistent Pain and Discomfort
This procedure is considered for patients experiencing ongoing shoulder pain, particularly for those whose daily activities are considerably impacted despite undergoing non-surgical treatments. - Failure of Conservative Treatments
In cases where conservative treatments such as physiotherapy, anti-inflammatory medications, and corticosteroid injections fail to alleviate symptoms over a considerable period, usually several months. - Limited Shoulder Mobility
Difficulty in performing overhead activities or movements due to restricted shoulder mobility, often accompanied by strength loss. - Structural Abnormalities
Presence of bony spurs in the subacromial space or changes in the acromion that contribute to the impingement of the rotator cuff tendons. - Rotator Cuff Tendonitis or Bursitis
Persistent inflammation of the rotator cuff tendons (tendonitis) or the subacromial bursa (bursitis) that does not respond to non-surgical management. - Diagnostic Imaging Findings
MRI or ultrasound scans showing significant structural issues in the shoulder that are likely to benefit from surgical decompression.
Benefits and Risks of Arthroscopic Subacromial Decompression
Benefits
- Pain Relief: The primary benefit is the reduction or elimination of pain caused by subacromial impingement.
- Improved Mobility: Patients often experience an increase in range of motion and shoulder function, making daily activities more manageable.
- Minimally Invasive: As an arthroscopic procedure, it involves smaller incisions, leading to less tissue damage and scarring compared to open surgery.
- Faster Recovery: The minimally invasive nature usually results in a quicker recovery time, allowing patients to return to normal activities sooner.
- High Success Rate: Many patients report a significant improvement in shoulder function and quality of life post-surgery.
Risks
- Surgical Complications: As with any surgery, there are risks of complications such as infection, bleeding, or adverse reactions to anaesthesia.
- Shoulder Stiffness: Some patients may experience stiffness in the shoulder post-surgery, although this is often temporary.
- Incomplete Symptom Relief: In some cases, the surgery may not completely alleviate all symptoms, especially in severe cases of impingement.
- Risk of Re-injury: There is a risk of re-injuring the shoulder, particularly if postoperative care and rehabilitation guidelines are not followed.
- Need for Further Surgery: In rare cases, additional surgery may be required if the initial procedure does not yield the desired results or if complications arise.
Preparing for Arthroscopic Subacromial Decompression
Preparation for Arthroscopic Subacromial Decompression is a key step in ensuring a successful outcome for the surgery. Patients should follow specific guidelines before undergoing the procedure:
Medical Evaluation
A comprehensive medical examination is necessary to assess the patient’s overall health status. This may include blood tests, ECG, and chest X-rays.
Shoulder Imaging
Detailed imaging studies such as MRI or ultrasound of the shoulder help in planning the surgical approach.
Medication Review
Patients should inform their orthopaedic surgeon about all medications they are taking, as some may need to be stopped or adjusted before surgery.
Smoking Cessation
Smoking can impede healing and increase the risk of complications. Patients are advised to quit smoking before the surgery.
Nutrition
A balanced diet can aid in recovery. Patients may be advised to increase their intake of certain nutrients that promote healing.
Alcohol Intake
Reducing or eliminating alcohol consumption before surgery can minimise the risk of bleeding and other complications.
Fasting
Patients will be instructed to fast for a certain period before the surgery to reduce the risk of anaesthesia-related complications.
Medication Instructions
Specific instructions regarding the continuation or cessation of certain medications will be provided.
What Can You Expect During an Arthroscopic Subacromial Decompression?
Arthroscopic Subacromial Decompression is typically performed as an outpatient procedure, meaning patients can go home the same day.
- Anaesthesia
The procedure is usually performed under general anaesthesia, ensuring the patient is asleep and feels no pain during the operation. - Incision and Insertion
Small incisions, typically less than an inch long, are made around the shoulder. Through these incisions, the arthroscope and surgical instruments are inserted. - Visualisation
The arthroscope, which has a camera attached, provides a clear view of the inside of the shoulder joint and subacromial space on a monitor. - Decompression
The orthopaedic surgeon uses specialised instruments to remove bone spurs and any inflamed or excess tissue in the subacromial space, thus relieving the pressure on the rotator cuff and bursa. - Closure
Once the decompression is complete, the incisions are closed with sutures or surgical tape and covered with a dressing.
Postoperative Care and Rehabilitation
Effective postoperative care and rehabilitation are crucial components of the recovery process following Arthroscopic Subacromial Decompression.
Immediate Postoperative Care
- Pain Management: Pain and discomfort can be managed with prescribed medications. It’s important to follow the dosage instructions provided by the healthcare team.
- Wound Care: Keeping the surgical area clean and dry is essential. Instructions on how to care for the wound and when to remove dressings will be provided.
- Shoulder Immobilisation: The shoulder may need to be immobilised with a sling for a period, as recommended by the orthopaedic surgeon.
Rehabilitation and Physical Therapy
- Early Mobilisation: Starting light shoulder movements early in the recovery process is often encouraged to promote circulation and flexibility.
- Physical Therapy: A structured physical therapy program, typically starting a few weeks post-surgery, is crucial. This program is designed to restore strength and range of motion in the shoulder.
- Gradual Progression: Rehabilitation exercises will gradually increase in intensity as the shoulder heals. It’s important not to rush this process to avoid setbacks.
Long-Term Care
- Follow-Up Appointments: Regular follow-up appointments with the orthopaedic surgeon are important to monitor the progress of recovery.
- Activity Modification: Gradual return to normal activities is advised. High-impact activities or those involving heavy lifting should be avoided until the surgeon gives clearance.
- Ongoing Exercise: Continuing with exercises to strengthen the shoulder even after formal physical therapy has ended can help maintain shoulder health and function.
Patient Feedback
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
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Frequently Asked Questions (FAQs)
How Long Is the Recovery Period After the Surgery?
The recovery period after Arthroscopic Subacromial Decompression varies but is generally phased. In the initial recovery phase, which lasts from 2 to 4 weeks post-surgery, the focus is on managing pain and inflammation while starting gentle mobilisation exercises.
The intermediate recovery phase extends from 4 weeks to 3 months, during which rehabilitation exercises are intensified to regain strength and flexibility.
The long-term recovery, where complete healing and return to all normal activities typically occur, can take between 3 to 6 months. This timeline varies based on individual factors such as healing rates and the complexity of the surgery.
Is the Arthroscopic Subacromial Decompression Procedure Painful?
Patients may experience some pain and discomfort following the surgery, but this is usually manageable with medications. The level of pain varies among individuals.
When Can I Return to Work After the Surgery?
The timeline for returning to work depends on the nature of the job. For desk jobs, it might be a few weeks, while physically demanding jobs may require a longer recovery period. It’s important to follow the orthopaedic surgeon’s advice on this matter.
Will I Have a Scar from the Surgery?
As the procedure is minimally invasive, the scars are typically small and less noticeable. However, some degree of scarring is inevitable.