When is surgery needed?

  1. Shoulder pain caused due to impingement
    • Bursa, a fluid filled pad becomes inflamed
    • When the arm is lifted the bursa becomes trapped and pinched and causes pain
  2. Surgery is recommended when
    • Physiotherapy and steroid injections are ineffective
    • Pain continues for 6-12 months

Surgery involves

  • Increasing the size of the subacromial area and reducing the pressure on the muscle
  • Cutting the ligament, shaving away the bony spur on the acromion bone and the inflamed bursa

What is an Arthroscopic Subacromial Decompression (ASAD) ?

Shoulder pain is a common symptom. There are many different causes, one of which is a shoulder impingement. In this condition a bursa (fluid filled pad that lies around your rotator cuff tendons of the shoulder) becomes inflammed. This bursa sits under the acromion bone (the bony arch at the top edge of your shoulder). Hence when the arm is lifted the bursa becomes trapped and pinched and causes pain.

The operation aims to increase the size of the subacromial area and reduce the pressure on the muscle. It involves cutting the ligament, shaving away the bony spur on the acromion bone and shave the inflammed bursa. This allows the muscle or tendon to heal.

What are the benefits of having an ASAD?

90 out of 100 patients after this procedure report significant pain relief with increased range of motion and strength in the shoulder. ASAD surgery is effective in selective patients with shoulder impingement syndrome.

Is shoulder decompression surgery painful?

The surgery is done through small cuts around your shoulder known as keyhole surgery. You may experience some pain due to surgery performed inside the shoulder for which you will be sent home on pain medication.

Your doctor may suggest this surgery if non-surgical treatment i.e. physiotherapy and steroid injections do not adequately relieve the shoulder pain and increase the range of motion. Surgery essentially creates more room for the soft tissues that are being squeezed.

What are the risks of surgery?

ASAD is a commonly done procedure and is generally safe. Complications include infection, nerve damage, bleeding, blood clots and stiffness to the shoulder. Altogether the risk is around 3-4%. In the experience of the author, it is a good procedure to have with minimal complications.

Are there any alternatives to surgery?

In most cases physiotherapy and steroid injections will help to reduce the pain. If however you continue to have pain 6-12 months down the line; then your doctor will recommend this procedure to you.

If shoulder impingement is left untreated, it can lead to more serious conditions such as a rotator cuff tear.

What happens during the surgery?

On the day of your surgery you will be seen by the doctor and the anaesthetist who will discuss the procedure and any possible complications and take consent from you. Your surgery will be done in a beach chair position (you will be positioned sitting up). It will be a keyhole surgery (arthroscopy). The surgeon will insert a camera into the shoulder and will watch the images on a screen. Pictures will be taken and a copy will be given to you at the time of discharge.

Our aim is to make more space under the acromion by removing some of the bone and bursa along with the ligament. At the same time your surgeon may decide to repair any damaged rotator cuff tendons, damaged biceps tendon etc.

Will I feel any pain after shoulder arthroscopic surgery?

Sometime the anaesthetist will give you a nerve block and your arm may feel numb for around 24 hours. Before you are sent home you will be given opioid and non-steroidal anti-inflammatory drugs to control pain.

What happens after the surgery?

You will go to recovery for a few hours and then go home the same day. You will need to keep the wound dressings dry for two weeks. You will be seen in clinic by a consultant at two weeks for a wound check and removal of sutures. In a pure arthroscopic subacromial decompression you will be given a sling for 2-3 weeks for the relief of pain. You can drive around 3-4 weeks as your pain and comfort allows. You will also be seen by a physiotherapist who will discuss further rehabilitation with you. You will be allowed full active range of motion exercises as your pain will allow. Your shoulder will continue to improve for 6-9 months.