Arthroscopic
Sub Acromial Decompression
A guide for patients
Gateshead Upper Limb Unit
Mr Andreas Hinsche
Mr John Harrison
Mr Jagannath Chakravarthy
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A bit about the shoulder
The shoulder joint consists of three bones. The humerus (arm bone), the scapula (shoulder
blade) and the clavicle (collar bone). The prominent bone felt on the side of the shoulder is
the acromion and is part of the shoulder blade. See picture below.
The shoulder is a ball and socket joint and is very mobile. Movement of this joint occurs
through the actions of a group of muscles called the rotator cuff. These muscles originate
from the shoulder blade and their tendons (the part of the muscle that attaches onto the
bone) which form a hood that covers the ball of your shoulder joint (the head of the humerus).
The tendons pass from the shoulder blade to the arm bone below the acromion (point of your
shoulder). Overlying the tendons is a fluid filled cushion called the bursa (see picture above)
this forms the subacromial space
What is sub-acromial impingement?
Sub-acromial impingement is a very common problem where the tendons of the rotator cuff
rub on the under-surface of the acromion. This is more common when the acromion has a
bony bump (hook). See picture below. The third type is commonly associated with
impingement and it is this hook which is removed by surgery.
Overlying the tendons is a fluid filled cushion called the bursa, this can also become
inflamed. Sub-acromial impingement can also be aggravated by poor posture.
What are the
symptoms?
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Pain is the commonest symptom. This is usually located
over the side of the arm. Pain is brought on by raising the
arm over shoulder level
Pain is also typically worse in the night time especially
if you sleep on your affected side
Stiffness can result from the severe pain.
Will I need any tests?
An x-ray would normally be done to assess the bone and acromion
Your surgeon might request an ultrasound scan to rule out a tear in your tendons.
Steroid injection though part of the treatment is also a very important test. Patients
who get good pain relief (even for a few hours) after an injection tend to do better
following surgery. Surgical recovery in patients having no benefit of the injection is less
predictable.
What are the treatment options?
Pain killers are helpful in mild cases
Physiotherapy is essential and can help avoid the need for surgery. The benefits of
physiotherapy are apparent only after a few months so please be patient.
Steroid Injections help reduce the inflammation and control the pain. In some
patients one or two injections are all that are required to control the pain. If you need
more than two injections then you may be offered surgery
Surgery is offered if all above have failed to control your symptoms.
What is a Subacromial decompression ?
It is an operation which involves increasing the space for your tendons but taking away the
bony hook mentioned before. The inflamed bursa is also removed and this helps control the
pain. This will allow the rotator cuff tendons to recover and improve your shoulder function.
This surgery is done arthroscopically (keyhole surgery), which helps to speed up recovery.
After surgery you will be left with 2 or 3 small scars around the shoulder. You might need
additional procedures which will be discussed by your surgeons.
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Picture and diagram showing the procedure on a right shoulder.
Are there any complications after this operation?
The risk of complications may vary from patient to patient. This is because this type of
surgery is specific to individual patients. Your consultant or physiotherapist will discuss any
individual risks or complications with you.
Generally the most common/ serious problems with this type of surgery are:
Infection ( this is extremely rare)
Shoulder stiffness
Recurring pain
How long will I be in hospital?
This operation is usually carried out as a day case. This means that you will usually spend
approximately half a day in hospital. You will either receive a general anaesthetic (put to
sleep) or be awake and have an injection to numb your shoulder.
What happens before the operation?
Before you are admitted you may need to have a pre-operative assessment. This is an
assessment of your health to make sure you are fully prepared for your admission, treatment
and discharge. Before the date of your admission please, read very closely, the instructions
given to you. If you are having a general anaesthetic you will be given specific instructions
about when to stop eating and drinking, please follow these carefully as otherwise this may
pose an anaesthetic risk and we may have to cancel your surgery. You should bath or
shower before coming to hospital.
The surgeon and anaesthetist will visit you and answer any questions that you have. You will
be asked to sign a consent form. A cuff will be put on your arm, some leads placed on your
chest, and a clip attached to your finger. This will allow the anaesthetist to check your heart
rate, blood pressure and oxygen levels during the operation. A needle will be put into the
back of your hand to give you the drugs to send you to sleep. Occasionally you might just
receive an injection into the side of your neck to numb your shoulder and you will remain
awake during the procedure if this is the case.
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What happens after the operation?
A nurse will check your blood pressure, pulse and the area where the operation has been
done. You will normally be able to have a drink shortly after the procedure and eat as soon
as you feel hungry.
You can usually get out of bed an hour or so after you wake up and you should wait for the
nurses to help you as you may feel a little dizzy at first. It is likely to be a bit painful where the
operation has been carried out, but if you move carefully, the pain is not usually severe. The
nurses will monitor your pain and give you painkillers, if necessary. It is quite normal for a
small amount of blood to soak through the dressing and this can easily be changed.
Sometimes the staff will need to press gently on the dressing for a while to prevent this
happening again.
You can usually go home when you are comfortable and the anaesthetic has worn off. The
effects may take some time to wear off fully even though you may feel fine, so you will need a
responsible adult to take you home and stay with you for the first 24 hours. During this time
you should not operate machinery, drive or make important decisions.
Before you go home the nurse will give you any further advice that you need and will give you
a supply of painkillers. We will send a letter to your GP to explain what you have had done.
Recovery after your surgery.
You may move your shoulder when you feel comfortable. It is normal to experience some
degree of discomfort after the surgery. This will improve with time and you should expect to
have 80% improvement of shoulder function by 3 to 6 months after surgery.
An appointment will be made for you to see a physiotherapist who will advise you on
exercises and progress these when you are ready. If you do not receive an appointment for
physiotherapy within 2 weeks of your operation please contact us on 4452320 and ask to
speak to a physiotherapist from the Upper Limb Team.
An appointment in the follow up clinic will also be arranged for between 6 weeks to 3 months
post surgery. This appointment will be with a member of the upper limb team.
When do the stitches come out?
If you have had stitches then they are usually removed between 10 and 14 days at your GP’s
surgery. You will be advised on this by the nursing staff, before you are discharged.
Do I need a sling?
On discharge from the ward you will be given a sling to give your arm support and help with
pain. The sling can be discarded as soon as you feel comfortable.
How do I sleep?
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Sleeping on your affected shoulder will increase your pain and it is therefore advised that you
sleep on your good side or your back.
If you choose to sleep on your good side it is a good idea to use pillows to support yourself. A
pillow can be tucked along your back to prevent you rolling onto your affected shoulder in the
night. Another one can be placed under your shoulder to give it support.
Side-lying
Lying on back
When can I return to my normal activities?
This can vary from person to person and is dependent upon your pain. Below is a rough
guide however, it is advisable to discuss this with your physiotherapist or surgeon before you
return to full activities.
Return to work
Driving
Swimming
Golf
Lifting
Racquet sports
Office work: as tolerated
Manual job: may need to modify activities for 3 months
2 weeks if pain allows
Breaststroke: as able
Freestyle:
12 weeks
6 weeks
as able
Avoid repetitive overhead shots for 3 months
Exercises
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Flexion
Abduction
Circumduction
1. Stand leaning on a
table with uninvolved
hand.
2. Let involved hand
hang relaxed
1. Stand leaning on a
table with uninvolved
hand.
2. Let involved hand
hang relaxed.
1. Stand leaning on a
table with uninvolved
hand
2. Let involved hand hang
relaxed
3. Swing arm forwards
and backwards.
3. Swing arm to the left
and then the right.
3. Swing arm as if
drawing a circle on the
floor.
Repeat in opposite
direction.
Flexion
1. Lying on back - grasp
wrist of involved arm
with other hand.
2. Reach overhead as far
as possible assisting
involved arm.
External Rotation
Lying on back with pillow
under elbow - elbows fixed to
90 degrees and held close to
the body.
Push involved arm outward
using the stick.
Telephone numbers
During the hours of 8am -8pm contact the Day Surgery Unit,
0191 4453009
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North East NHS Surgery Centre, Queen Elizabeth Hospital
During the hours of 8pm -8am contact Level 1, North East
NHS Surgery Centre, Queen Elizabeth Hospital
0191 4453005
During the hours of 0800 -1630 contact the Physiotherapy
Department (please ask for a member of the upper limb team)
0191 4452320
Main switchboard
0191 4820000
Data Protection
Any personal information is kept confidential. There may be occasions where your
information needs to be shared with other care professionals to ensure you receive the best
care possible.
In order to assist us improve the services available your information may be used for clinical
audit, research, teaching for National NHS Reviews your name or personal details will remain
anonymous. Further information is available in the leaflet Disclosure of Confidential
Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS
Service.
Useful Organisations

www.shoulderdoc.co.uk
Please go to the patient information link on the website
www.patient.co.uk

Patients Association
PO Box 935
Harrow
Middlesex
HA1 3YJ
Tel Helpline: 0845 608 4455
www.patients-association.com
Provides a helpline, information and advisory service. It also campaigns for a
better health care service for patients.
Information Leaflet:
Version:
Title:
First Published:
Last Reviewed:
Review Date:
Author:
NoIL255
2
Arthroscopic Sub Acromial Decompression
July 2006
October 2012
October 2014
Gateshead Upper Limb Team
This leaflet can be made available in other languages and
formats upon request
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