What is subacromial decompression surgery?

What is subacromial decompression surgery?

‍

Subacromial decompression is a surgical procedure performed to relieve shoulder impingement syndrome. Shoulder impingement occurs when the tendons of the rotator cuff and the subacromial bursa (a fluid-filled sac) become compressed or pinched between the head of the humerus (upper arm bone) and the acromion process (a bony prominence of the shoulder blade).

‍

The subacromial space is the area between the acromion and the humeral head. In some individuals, this space becomes narrowed due to various reasons, such as inflammation, overuse, bone spurs, or structural abnormalities. As a result, the rotator cuff tendons and the subacromial bursa may get trapped or irritated when the arm is lifted, leading to pain, limited range of motion, and weakness in the shoulder.

‍

Subacromial decompression is performed to increase the volume of subacromial space and provide adequate gliding room for tendons, which helps to alleviate the compression on the rotator cuff tendons and the bursa. This is typically achieved through an arthroscopic procedure, which involves making small incisions and using a camera (arthroscope) to visualize the inside of the shoulder joint.

‍

During the surgery, the surgeon may remove inflamed or damaged tissue, shave down bone spurs, or reshape the acromion to increase the subacromial space. By doing so, the pressure on the rotator cuff tendons and the subacromial bursa is reduced, and the symptoms of shoulder impingement are relieved.

‍

Subacromial decompression is often performed in combination with other shoulder procedures, such as rotator cuff repair or labral repair, if there are additional shoulder problems that need to be addressed.

‍

After subacromial decompression surgery, patients typically undergo a rehabilitation program, including physical therapy, to restore shoulder strength, flexibility, and function. The recovery process aims to gradually return the shoulder to normal function and improve the individual's quality of life by reducing shoulder pain and restoring shoulder mobility.

‍

When would a patient need subacromial decompression surgery?

‍

Subacromial decompression can benefit individuals who experience shoulder impingement syndrome that causes severe pain and loss of functional mobility and do not respond to conservative treatments. 

‍

Subacromial decompression surgery may be recommended when the patient has the following signs and symptoms: 

‍

1. Persistent shoulder pain and loss of functional mobility: Pain during overhead activities and loss of functional mobility of the shoulder as the result of impingement that persists (typically for 3 to 6 months or longer) despite of conservative treatments, subacromial decompression may be prescribed.  
2. Failed conservative treatments: If conservative treatments, such as rest, physical therapy, corticosteroid injections, and activity modification, have not provided adequate relief from shoulder impingement symptoms, surgery may be the next step.
3. Presence of bone spurs: If imaging studies, such as MRI or X-rays, reveal the presence of bone spurs or other structural abnormalities causing narrowing of the subacromial space, subacromial decompression may be recommended.
4. Tendon tears: Subacromial decompression can be performed in conjunction with rotator cuff repair surgery when there are partial or full-thickness tears of the rotator cuff tendons.

‍

It's important to note that not everyone with shoulder impingement will require surgery. Many cases of shoulder impingement can be effectively managed with conservative treatments, such as physical therapy, rest, and anti-inflammatory medications. Subacromial decompression is typically considered after conservative treatments have been tried and failed to provide sufficient relief.

‍

The decision to undergo subacromial decompression surgery should be made in consultation with an orthopedic surgeon who specializes in shoulder conditions. The surgeon will thoroughly assess your shoulder condition, medical history, response to conservative treatments, and overall health to determine if subacromial decompression is the most appropriate treatment option for your specific case.

‍

After subacromial decompression: What to expect

‍

After subacromial decompression surgery, the recovery process is crucial to ensure proper healing and successful rehabilitation. Here's what you can generally expect during the recovery period:

‍

1. Hospital stay: Subacromial decompression is typically performed on an outpatient basis, meaning you can go home the same day of the surgery.
2. Pain management: You may experience pain and discomfort in the shoulder after the surgery. Your healthcare team will prescribe pain medications to manage post-operative pain.
3. Immobilization: You may need to wear a sling with the arm positioned at the patient’s side or in slight abduction (positioned away from the body), the shoulder is internally rotated (rotated inwards); and the elbow is flexed to 90 degrees. The sling is usually worn for comfort for 1 to 2 weeks but can be removed only during exercise. 
4. Early motion: Gradual and gentle shoulder motion exercises will begin the day after surgery  to prevent stiffness and promote healing.
5. Physical therapy: Physical therapy is a crucial component of the recovery process. You will start physical therapy exercises to restore shoulder strength, flexibility, and function.
6. Gradual return to activities: Your surgeon and physical therapist will guide you in a step-by-step approach to return to daily activities and work. Returning to more strenuous activities and sports will depend on your recovery progress and your surgeon's recommendations.
7. Follow-up appointments: You will have regular follow-up appointments with your surgeon to monitor your progress and make any necessary adjustments to your treatment plan.
8. Timeframe for full recovery: The recovery period for subacromial decompression surgery varies from person to person. While some individuals may experience significant improvement within a few weeks, it may take several months to achieve full recovery and return to normal activities.
9. Restrictions: Your surgeon will provide guidelines and restrictions for activities that should be avoided during the initial healing phase to protect the shoulder.

‍

It's essential to follow your surgeon's and physical therapist's instructions diligently to ensure a successful recovery. The rehabilitation process may take time, and your healthcare team will guide you throughout the recovery process, addressing any concerns and ensuring your safety and well-being. With proper care and commitment to your rehabilitation program, you can expect improved shoulder function, reduced pain, and a successful return to your daily activities and desired level of function.

‍

How can physical therapy help? 

‍

Physical therapy is a crucial component of the recovery process after subacromial decompression surgery. A physical therapist will design a customized rehabilitation program to promote healing, restore shoulder strength, flexibility, and function, and gradually guide you back to your normal activities and sports. Here's how physical therapy can help with subacromial decompression surgery:

‍

1. Pain management: Physical therapists use various  modalities such as ice, heat, and electrical stimulation to manage post-operative pain and reduce shoulder swelling. Shoulder relaxation exercises may also be prescribed to help reduce the stress on the affected shoulder.
2. Range of motion exercises: Early after surgery, physical therapists focus on a gentle range of motion exercises such as passive to active range of motion with or without assistance to prevent shoulder stiffness and maintain joint mobility. As the patient improves, manual and self-stretching exercises in pain-free ranges as well as joint mobilization are prescribed to increase shoulder muscle flexibility and range of motion.
3. Strengthening exercises: As healing progresses, physical therapists prescribe progressive strengthening exercises. It includes dynamic strengthening of isolated shoulder muscles against low-loads (1- to 5-lb weight or light-grade elastic tubing), with gradually increasing repetitions and resisted elevation of the arm in varying positions (lying at the back, sitting or standing). These exercises will help to increase muscle strength, endurance and performance.
4. Scapular and shoulder stabilization: Stabilization exercises against increasing resistance and in weight bearing positions are prescribed. Emphasizing isolated strengthening of the serratus anterior and trapezius muscles (these are the muscles that move and stabilize the scapula). This type of exercise will help the patient to develop dynamic stability and strength of the scapulothoracic and shoulder muscles. 
5. Postural training: Physical therapists usually prescribe postural training to develop postural awareness and control. It helps the patient recognize and avoid postures that contribute to symptoms during exercise and activities of daily living.
6. Return to activities: The recommended timelines and criterias to return to a pre-injury level of activity may vary for each patient depending on clinical examination findings, particularly the shoulder muscle strength, the stability of the shoulder joint and the expected work-related, recreational or sports-related demands. 
7. Functional training: A final component of an individualized rehabilitation program involves practicing activities that simulate the physical demands of a patient’s work or desired recreational or sport activity. Simulated activities and drills enable a patient to practice under supervised conditions to receive feedback on correct mechanics. 
8. Patient education: Physical therapists educate the patients about subacromial decompression, its indications and benefits as well as the role and importance of postoperative rehabilitation programs. They also teach patients about proper shoulder care, activity modifications, and injury prevention strategies.
9. Home exercise program: A specialized home exercise program is provided by the physical therapists. They also teach patients how to safely incorporate it into their daily routine to reinforce the interventions and for optimal recovery. 
10. Progress monitoring: Physical therapists continually monitor your progress and adjust the treatment plan as needed to ensure a successful recovery.

‍

Physical therapy plays a significant role in optimizing your recovery after subacromial decompression surgery. The therapist's expertise and guidance are essential to ensure proper healing, prevent complications, and help you regain shoulder strength, mobility, and function. Consistent participation in physical therapy exercises and adherence to your therapist's recommendations will lead to the best possible outcome, allowing you to return to your desired level of activity and sports participation safely and effectively.

Trust PeteHealth for recovery from subacromial decompression

Looking for a physical therapist to help you recover from subacromial decompression surgery? PeteHealth is the trusted physical therapy solution that you can access on your schedule, bringing you the care you need wherever you need it – including your home or office. Our licensed physical therapists are at the top of their profession, and we accept most insurance carriers.

‍

Finally – the all-in-one, professional, convenient approach to physical therapy that you deserve with PeteHealth.

‍