Subacromial IMPINGEMENT is a condition where the inflammed bursa and/or the rotator cuff tendon is pinched between the humeral head and the undersurface of the acromion. If your symptoms do not improve after a course of conservative treatment, consisting of anti-inflammatory medication and physical therapy, an Arthroscopic Subacromial Decompression may be the next step in your treatment.
A Subacromial Decompression is an arthroscopic (keyhole) procedure using instruments inserted through small incisions. One of the instruments inserted is a video camera about the size of a pencil. Another instrument called a shaver is inserted through the other incision. The shaver is used to remove the inflamed bursa. Once the bursa is removed, the rotator cuff is inspected to look for any signs of a tear. Sometimes there is a bone spur. In this instance a burr is used to smooth off the osteophytes (bone spurs) under the acromion to remove this as a source of impingement
Keyhole surgery results in a quick recovery. A sling is only needed for the first 24 hours till the nerve block wears off (see below). Then you can start to move your shoulder as much as possible. Patients are encouraged to move their shoulder as much as possible, immediately after surgery. Failure to do so will result in stiffness and formation of scar tissue in the subacromial space. Strengthening can begin within a few weeks, and sports can resume after full pain free movement is achieved.
Complications from arthroscopy are uncommon but include:
- Excessive swelling of the shoulder
- Damage to blood vessels or nerves
Patients will often have a nerve block under sedation when having a shoulder arthroscopy, subacromial decompression, rotator cuff tendon repair and/or stabilisation. Once the block is placed (which takes about 10 minutes), more medication will be given resulting in general anaesthesia. You will be asleep for the surgery.
- The type of block is called an interscalene Brachial Plexus block.
- The effect of the nerve block is to make your shoulder/arm numb
- Your arm will be numb and immobile for 8-16 hours following the surgery
- Interscalene blocks have a success rate of about 95%
- It is a safe procedure and complications are rare
- Local anaesthetic is injected around the nerves to block the sensation from the body i.e. arm/shoulder
- An ultrasound is used to see the nerves to allow precise placement of the local anaesthetic.
- You may experience tingling in the arm as the block wears off
- Normal muscle strength and sensation should return within 24 hours
- Take regular Paracetamol for 5 days after surgery i.e. 1000mg four times per day
- If further analgesics are required, take the prescribed pain medications when required
- Areas of numbness, weakness and tingling in the arm (1 in 2500)
- Prolonged permanent nerve damage (1 in 6666)
- Local anaesthetic spreading into the blood stream and causing illness (1 in 1000)
- All wounds are closed with “dissolving “ stitches and covered with waterproof dressing.
- Leave bulky dressing undisturbed for 48 hours.
- Remove bulky dressing after 48 hours.
- Leave waterproof dressing on till review by Dr Sim in two weeks.
- You may shower and get waterproof dressing wet.
- Remove the sling once the nerve block wears off and you have regained movement and feeling in the arm (usually 16-24 hours after the surgery).
- You will need to book physiotherapy, this should start 2-3 days after surgery.
- Move your shoulder AS MUCH AS POSSIBLE.
- You will not cause any harm/damage to your shoulder by moving it even though it is painful.
- Swelling. This may track all the way down your arm to your fingers due to gravity. This is normal. Keep using your arm and hand to help the muscles “pump” the fluid away.
- Clear / Blood Stained discharge from wound. THIS IS NORMAL for the first few days. It will clear up on its own.
- Pain. You will receive a prescription for pain medication on discharge. Pain relief medication works best if taken REGULARY.
- Excessive persistent pain
- Pus discharge from wound
Should any of these symptoms persist contact Dr Sim’s rooms or after hours emergency.