Subacromial Decompression: Surgery & Recovery

Instructor: Meghan Greenwood

Meghan has taught undergraduate and graduate level science courses and has a PhD in Immunology.

This lesson will describe subacromial decompression surgery and what it is used to treat. The length of time and proper techniques used for a rapid recovery will also be discussed.

Subacromial Impingement

Think of the last time you went swimming. Even if you're not a trained swimmer with a perfect breaststroke, you likely still used your arms to paddle yourself towards the end of the pool or to the shore. With each stroke, your arms and shoulders move in unison to create a rotating motion. The shoulder itself is made up of multiple bones, tendons and ligaments, all specifically placed to enable free and painless movement. The humerus, or the long arm bone that connects into the shoulder, contains a rounded head that looks like a ball. On top of the ball is the rotator cuff tendon and the bursa, a fluid-filled sac which acts as a cushion between the humerus and the acromion. The acromion is a finger-like projection on the corner of your shoulder blade. Together, these anatomical features make up your rotator cuff and allow for a range of motions, like swimming, throwing and lifting.

The humerus and acromion come together to form the rotator cuff. Tendons and the bursa lie in between the two bones, creating a cushion for movement.
shoulder anatomy

Now imagine that you have a friend with you and with each stroke of your friend's arm, he feels a pinch. Depending on the degree of inflammation and injury, his pain may gradually increase with each use of the shoulder, or it may come on suddenly and potently. Subacromial impingement occurs when the tendon and bursa below the acromion (hence, subacromial) is rubbed against or narrowed on the top of the humerus, causing irritation and pain. Subacromial impingement may be the result of repetitive shoulder motions, like if you were part of the swim team, or it can sometimes develop with no apparent cause. Nonetheless, if the pain doesn't subside with over the counter anti-inflammatory medications or physical therapy, your friend may have to undergo more invasive techniques.

Subacromial Decompression Surgery

In order to alleviate the pain of subacromial impingement, subacromial decompression surgery is utilized. The overall goal of the surgery is to create more space in between the acromion and humerus, effectively stopping the rubbing on the tendons. Oftentimes, the excessive rubbing plus localized inflammation causes bone spurs to appear. Bone spurs are tiny projections that stick out from the bone.

The doctor will start your friend's surgery by first delivering either a general anesthetic or local anesthetic and then performing an investigation of the rotator cuff, looking for bone spurs and tendon/bursa inflammation. They can visualize the shoulder in one of two ways: arthroscopically or openly. Arthroscopic surgery takes advantage of medical visualization techniques, like small video cameras, to guide surgical instruments into the shoulder, whereas open surgery is an incision that allows the doctor to visualize the shoulder with the naked eye. Arthroscopic surgery is less invasive, but regardless of the technique, subacromial decompression typically involves removal of any bone spurs on the acromion and sometimes cutting away a portion of the acromion, bursa or tendon tissue. Once the rotator tendons can move freely in between the humerus and acromion, your friend is good to go, and the surgery is completed.

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