Subacromial Smoothing and Acromioplasty for Rotator Cuff Disorders

Surgery Overview

Surgery may be used to treat a rotator cuff disorder if the injury is very bad or if nonsurgical treatment has not improved shoulder strength and movement enough.

Subacromial smoothing involves shaving bone or removing growths on the upper point of the shoulder blade (acromion ). It removes damaged tendon and bursa from the joint. The surgeon may also remove small amounts of bone from the underside of the acromion and the acromioclavicular joint. (This is called acromioplasty.) The goal is to take away roughness while keeping as much of the normal supporting structures as possible. This surgery makes more room in the subacromial space. With more space, the rotator cuff tendon is not pinched or irritated. It can glide smoothly beneath the acromion. But not all experts agree these procedures will help.

Subacromial smoothing, acromioplasty, and rotator cuff repair may be done using arthroscopic surgery or open surgery.

• Open-shoulder surgery involves making a larger incision in the shoulder, to open it and directly view the repair.
• Arthroscopy uses a thin viewing scope called an arthroscope. The scope is inserted into a joint through a small incision in the skin. Then the surgeon will remove loose fragments of tendon, bursa, and other debris from the shoulder. (This is called debridement.) Other tools are then inserted through the incision to shave the bone or remove growths. This type of surgery is more common than open surgery and often doesn't need a hospital stay.

You may have general anesthesia during arthroscopy, or you may have a regional nerve block.

• If a nerve block alone is done, you may be awake. You won't feel any pain. But you may feel some pulling or tugging during the procedure.
• At the start of the procedure, regional nerve blocks are sometimes used along with general anesthesia to help limit pain after surgery.

What To Expect

You will likely go home a few hours after you wake up from anesthesia. A family member or friend should drive you home. You will probably need help from friends or family for the first 2 weeks after surgery.

Discomfort after surgery may be relieved by:

• Applying ice to the surgical site several times a day, as directed. Always keep a cloth between your skin and the ice pack.
• Taking pain medicines as prescribed.
• Immobilizing and protecting your shoulder by wearing a sling as directed. Your doctor will advise you whether you need a sling after surgery. Some doctors don't recommend this, because the shoulder joint may become stiff.

With a doctor's approval, you may be able to return to light work within a few days after surgery even if you are using a sling.

Physical therapy after surgery is crucial for a successful recovery. A typical rehabilitation schedule includes:

• Range-of-motion exercises. These may start the day after subacromial smoothing surgery.
• Strength training. It may start a few weeks after surgery.

Normal shoulder strength and range of motion often return after several weeks. Then you can gradually increase your activity level.

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Why It Is Done

Smoothing may be done for people who:

• Have severe pain and impaired shoulder function that has not responded to a few months of conservative treatment.
• Are older adults with severe rotator cuff tears and whose main problem is pain, not weakness.
• Do not wish to have more extensive surgery to repair a rotator cuff tear.

Also, if you have a rotator cuff tear, smoothing may be part of rotator cuff repair surgery.

How Well It Works

Surgery to smooth the bones and create more space for the rotator cuff may lead to less pain with shoulder movement. But not all experts agree that this procedure will help.

Risks

Along with the general risks of surgery, such as blood loss or problems related to anesthesia, complications of this surgery may include:

• Lasting pain.
• Stiffness or a frozen shoulder.
• Infection.
• Nerve or blood vessel injury.
• Fractures. If too much bone gets shaved off during surgery, the upper edge of the shoulder blade may get weak. A fracture might occur.