Arthroscopic acromioplasty

acromioplasty shoulder, subacromial decompression

What is an acromioplasty of the shoulder ?
The impingement syndrome is an entrapement of the supraspinatus tendon and bursa between the humeral head and the acromion ( the roof of the shoulder ). Normally, the supraspinatus / rotator cuff tendon is sliding in the tunnel between the acromion and the humeral head. The roof of this tunnel consist out of the coracoid process, in the front, and a ligament deriving from this process and inserting at the bony roof, the acromion, on top of this tunnel. From top of this tunnel the bony roof, the acromion, is composing the rear part of this area.
Different situations, affecting this tunnel, can lead to complaints like pain, the so called impingement syndrome. A cuff tear can cause such complaints, because the borders of this tear are bulging and causing an entrapement. A swollen and inflammed bursa may lead to enormous pain, because the inflammed and thickened bursa can not find another way and is entraped between the bony structures of the humeral head and the bony acromion. There is no way out for such an inflammed soft tissue. A calcium deposit, within this tunnel, especially when lifting the arm, can be entraped in this tunnel and leading to pain in this way. A curved or hooked acromion may also narrow the tunnel cause pain and induce a cuff tear when it is compressing the rotator cuff tendon long enough.
The way to operate an impingement / performing an acromioplasty:
If non-operative treatment failed, the tunnel will be widened arthroscopically by using special burs. Nearly all of these operations are performed endoscopically. Inflammed structures, like the bursitis, are removed by shaving. The bursa will grow within a few weeks after such an operation - uninflammed.
The term decompression or acromioplasty describes a kind of release of the narrowed subacromial tunnel. Using skin incision of about 0.5 - 1 cm, the endoscope is placed from the back and burs, shavers and so on are positioned using a lateral port. Using a precision bur, bone is removed from the undersurface and anterior part of the acromion. An inflammed bursa is removed or calcium deposits are cleared.
Sometimes the acromiopasty is performed as a single operation and sometimes it is combined with other operations like a lateral clavicle resection or rotator cuff repair, if there is an arthrosis at the acromioclavicular joint or a rotator cuff tear.
At the bottom of this page you can see a video of an acromioplasty. Just press the Play button.
A lot of these procedures are performed on an outpatient basis. If patients are suffering from significant other diseases or social control is not adequate, they will stay in hospital for 1 to 3 days.


Rehabilitation after an acromioplasty:
If an acromioplasty is performed as a single operation. The patient is allowed to use the arm at once, actively. No splint is necessary. Depending on the kind of work, you can return to it between 1 or 4 weeks. Patients with heavy labour can return to work after about 6 weeks. Sport is depending on the discipline. For example: Jogging is no problem and sport using the arms / shoulders like baseball, basketball, tennis and so on, should be avoided for about 6 to 12 weeks.


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