Introduction
Shoulder pain is one of the common complaints in orthopedic clinics worldwide, and shoulder impingement syndrome is one of the main reasons behind it. It limits the movement of the shoulder joint, causing pain when the edge of the shoulder blade (acromion) rubs or impinges against the rotator cuff muscles (a group of four muscles responsible for shoulder stability), leading to inflammation. Shoulder impingement syndrome is primarily seen in individuals involved in sports activities such as volleyball, handball, and swimming or in painters, carpenters, and hairdressers. Acromioplasty is a decompression surgery performed for shoulder impingement syndrome to relieve pressure and improve the movement of the joint.
What Is Acromioplasty?
Acromioplasty is a surgical procedure that is performed to remove a small part of the acromion, damaged cartilage, or an inflamed bursa that is causing pain and discomfort. It can be done arthroscopically (without opening the joint), which creates more sliding space for the tendons and removes the impingement. It is also known as arthroscopic shoulder decompression surgery. It is a procedure usually done along with rotator cuff repair. It is recommended in patients experiencing shoulder pain during overhead activities, especially in sports persons. The advantage of this surgery is that it causes minimal blood loss, less pain, smaller incisions, assessment of the joint without causing any damage to the muscles, and a faster postoperative recovery. It provides excellent results when non-surgical treatment options fail to show any improvement for the patient.
What Are the Types of Acromioplasty?
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Open or Decompression Acromioplasty: This technique is well-researched and documented, and the outcome of the procedure is also good, according to several clinical studies. Surgeons recommend an open acromioplasty in cases of failure of the arthroscopic procedure, chronic impingement, or young patients with refractory stage II impingement. However, they believe that the surgery must be delayed until the patient has failed various nonoperative treatment methods.
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Arthroscopic Acromioplasty: This procedure has multiple advantages compared to conventional decompression acromioplasty. It is a non-invasive procedure and also facilitates the evaluation of the glenohumeral joint, the rotator cuff muscles, and any associated pathology. It provides excellent results and also offers easier rehabilitation.
What Are the Common Conditions That Are Treated by Acromioplasty?
Some of the conditions that are treated by acromioplasty include;
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Shoulder instability.
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Shoulder impingement (muscles of the arm pinched between the shoulder bones) causing severe pain.
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Rotator cuff injuries.
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Bone spurs (bony projections).
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Bursitis (inflammation of the bursa).
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Arthritis (inflammation of the joints).
What Are the Instructions for the Arthroscopic Acromioplasty Procedure?
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The day before surgery, the patient is instructed to avoid eating or drinking anything after midnight.
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Arthroscopic acromioplasty is performed under regional anesthesia; hence the patient will not feel any pain or discomfort during the surgery.
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The patient is asked to bring a loose or an oversized button shirt to wear after the surgery.
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The duration of the surgery is approximately one hour, following which the patient can go home.
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Most of the patients recover within six weeks of surgery which is followed by physical therapy.
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Physical therapy helps to regain shoulder strength and decreases the risk of further complications.
How Is Acromioplasty Performed?
The healthcare professional initially reviews the symptoms and records the medical history of the patient. A physical examination is performed of the affected area, and radiographic imaging such as MRI or CT is recommended. The type of acromioplasty procedure performed depends on the injury, the repair to be performed, and the general health condition of the patient. The arthroscopic procedure is usually done under regional anesthesia.
Arthroscopic acromioplasty is a minimally invasive procedure during which the orthopedic surgeon performs a small incision in the affected area of the shoulder through which an arthroscope (a small fiber-optic instrument) is inserted. This device consists of a lens, light source, and a camera that captures the images, which are then displayed on a computer screen to be evaluated by the doctor. Debridement or cleaning of the tissues is done using a surgical shaver, and the damaged bursae, bony spurs, or cartilage is removed. Additional small incisions are made depending on the level of injury, such as shoulder impingement, shaving the extra bone growth or repairing the tendon tears, shoulder instability, etc. After the procedure is completed, the incision is sutured, and the patient is moved to the recovery room.
What Are the Complications of Acromioplasty?
The majority of the patients who undergo acromioplasty recover completely; however, certain complications may occur, which include:
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Injury to the nerve.
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Excessive bleeding.
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Joint stiffness.
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Infection at the surgical site.
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Persistence of pain even after surgery.
What Does the Recovery Phase Include Following an Acromioplasty Procedure?
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Non-steroidal anti-inflammatory drugs (NSAIDs) such as Acetaminophen, Ibuprofen, Naproxen, etc., and ice therapy are advised to manage pain.
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A sling is advised by the doctor to immobilize the shoulder when the healing occurs. The patient is hence instructed to rest for a few weeks and not to lift heavy things.
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Physical exercises include rehabilitation and range of motion exercises to enhance the strength and flexibility of the joint.
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Most people return back to work, school, or other normal activities after three to five days. Higher physical activities or sports can be gradually started after four to five weeks but under the guidance of a physical therapist and surgeon’s approval.
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Follow-up appointments are recommended after one month and three months after the surgery.
What Is the Outcome of Acromioplasty?
According to the American Board of orthopedic surgery, the incidence of acromioplasty has increased and become popular in recent years. However, there are differences in opinion in comparison with the conventional open surgical technique. Some of the potential benefits include improved visualization of the tissues through the arthroscopic procedure and better and quick healing response in the subacromial space.
Conclusion
Shoulder impingement syndrome is the most commonly diagnosed disorder, which accounts for about half of all shoulder complaints. Arthroscopic acromioplasty has become popular in recent decades as it involves small incisions, less bone removal, causes minimal pain, and a faster recovery. With regular physical therapy, it can take around three to six months for the patient to experience complete pain relief following the acromioplasty procedure.
