Shoulder decompression - keyhole surgery at Haywards Heath Hospital

What is shoulder decompression surgery?

Shoulder decompression is keyhole surgery that creates more space around the tendons in your shoulder, easing the rubbing and pinching that causes shoulder impingement pain. Your surgeon does this by shaving away a small amount of bone and removing inflamed tissue from underneath the bony arch of your shoulder blade, called the acromion.

What conditions does it treat?

This surgery treats subacromial shoulder impingement, sometimes called rotator cuff tendinopathy or subacromial bursitis. This is a common cause of shoulder pain, where a tendon catches on bone or nearby tissue as you move your arm.

You might be offered this surgery if:

• you have persistent or worsening shoulder pain, despite an adequate course of non-surgical treatment such as physiotherapy and exercise
• your pain is centred around your shoulder and upper arm, and may spread towards your neck or shoulder blade
• your pain is worse when lifting, reaching overhead, reaching behind your back, or lying on the affected side
• you've developed stiffness or a loss of movement because you've been avoiding using the shoulder.

This operation is for pain that isn't explained by other issues, such as a torn rotator cuff, pain in the joint at the top of your shoulder (the acromioclavicular joint), or calcium deposits in the tendon. If your surgeon finds one of these during your operation, they may treat it at the same time.

What are the benefits of shoulder decompression?

The aim of this surgery is to reduce your pain and improve how your shoulder functions, by giving the rotator cuff tendon more room to move freely. With less rubbing and friction in the joint, swelling and irritation can settle, giving the muscle a chance to heal.

Surgery is usually only offered once physiotherapy and exercise haven't given enough relief, so for many people reaching this point, it offers a way forward when other treatments haven't worked well enough.

Are there different types or surgical approaches?

This operation, also called an acromioplasty, is usually done as keyhole (arthroscopic) surgery through 2 to 3 small incisions, using a tiny camera and instruments. Keyhole surgery like this generally allows for a quicker recovery than open surgery.

Depending on what your surgeon finds once they're inside your shoulder, you might also have other procedures at the same time, such as:

• cleaning up or repairing a tendon. A repair means you'll need to wear your sling for longer, with more restrictions afterwards
• releasing the tendon of your biceps muscle, called a biceps tenotomy, which changes the shape of your upper arm muscle, sometimes nicknamed a 'popeye' sign
• releasing tightened tissue around the joint capsule, to help with stiffness.

What happens before the operation?

Before your operation is booked, you'll usually need to have tried physiotherapy and exercise for a good period without enough improvement, since surgery is generally only offered once these haven't relieved your symptoms.

Once your operation is booked, it helps to prepare in advance:

• attend a pre-admission assessment, where you'll be asked about your health, and should bring a list of your current medicines and any allergies
• plan for your recovery at home, such as stocking your freezer with easy meals and arranging for family or friends to help, especially in the first couple of weeks
• if you smoke, consider stopping beforehand, since smoking can delay wound healing and increase the risk of complications
• speak to your GP if you'd like support with your weight, since a higher body mass index increases the risk of serious complications during and after surgery.

On the day, follow your fasting instructions carefully, have a bath or shower before you come in, and you'll be asked to sign a consent form after a final chance to ask questions.

What happens during the procedure?

1. Monitors are attached to check your heart rate, blood pressure and oxygen levels throughout.
2. You have a nerve block, an injection that numbs your arm and shoulder, often combined with a general anaesthetic to put you fully to sleep.
3. Your surgeon makes 2 to 3 small incisions around your shoulder.
4. They pass a small camera through one incision to see inside your shoulder, and instruments through the others.
5. They cut the tight ligament at the front of the acromion (the bony arch of your shoulder blade) and shave away a small amount of bone and any inflamed tissue from underneath it.
6. If needed, they treat any other issues they find, such as a damaged tendon, at the same time.
7. The incisions are closed, usually with small stitches or adhesive strips.

What does recovery look like?

In hospital, this is usually a day-case procedure, so most people go home the same day, though you may need to stay overnight depending on your recovery and circumstances at home.

Before you leave:

• your dressing and sling will be in place, and a physiotherapist will see you and give you an exercise leaflet to work through at home
• your arm may feel numb from the nerve block for several hours. Once this wears off, your shoulder is likely to feel sore, and you'll be given painkillers to help.

At home:

• keep your wound dry until it's healed, usually 10 to 14 days, and your stitches will usually be removed at around 1 to 2 weeks, at your GP surgery or outpatient clinic
• ice packs, such as frozen peas or crushed ice wrapped in a damp cloth and used over cling film to protect your dressing, can help with pain, for up to 15 minutes at a time
• pain is often significant for the first 6 weeks. Take the painkillers you're given regularly
• how long you need your sling varies between sources, from a few days up to 3 weeks, and longer if you've had an additional procedure like a tendon repair. Follow the specific advice from your own surgical team
• start your prescribed exercises from day 1, and attend outpatient physiotherapy, usually starting around 1 week after surgery. This continues for several months
• avoid driving for around 2 to 4 weeks, until you're out of your sling and feel fully in control of the vehicle
• avoid heavy lifting for at least 4 weeks, and avoid repetitive or sustained overhead activity for about 3 months.

Guidance on returning to work varies by source and by how physical your job is. Sources suggest office-based work can often restart within 2 to 4 weeks, while manual or heavy manual work may need anywhere from 4 weeks up to 3 months, so talk to your surgeon or physiotherapist about what's realistic for your role.

Overall, you're likely to notice most of your improvement within the first 3 months, with recovery continuing for 6 to 9 months in total.

What are the risks and complications?

All surgery carries some risk. Your surgical team will discuss these with you, but they can include:

• significant pain, especially in the first 6 weeks, which can occasionally persist or not fully resolve
• stiffness, which usually improves over time but occasionally needs further treatment
• infection of the wound, in less than 1% of people
• bleeding during or after surgery, in less than 1% of people
• nerve injury causing numbness or tingling, in less than 1% of people. This usually settles, though rarely it can be permanent
• damage to nearby tissue
• a blood clot in the leg (DVT) or lungs (pulmonary embolism), which is uncommon
• a reaction to the anaesthetic
• your symptoms not fully resolving, or needing further surgery in future
• scarring, which is usually red at first but normally fades to a thin, pale line within a year.