Definition and Overview
An acromioplasty, also known as subacromial decompression, is a surgical procedure that involves the acromion, the triangular-shaped bone found in both shoulders. In this arthroscopic procedure, a small piece of the body part is removed to prevent or relieve the friction that develops when the bone comes into contact with a tendon.
The acromion is connected to the shoulder blade and extends toward the shoulder joint. Along with the collarbone, it forms the acromioclavicular joint and is also connected to the scapular spine. Due to repetitive movements of the shoulders, the surface of the acromion may become damaged, causing the bone to rub against the tendons in the shoulder.
Who Should Undergo and Expected Results
An acromioplasty or subacromial decompression is beneficial for patients who suffer from an acromioclavicular joint injury, which commonly affects males over the age of 35.
The procedure is typically performed to repair AC joint injuries related to overuse, as constant strain on the acromion bone can damage the cartilage. When this occurs, the bone comes into direct contact with the tendons, increasing the risk of serious tendon damage and causing some symptoms, such as:
- Loss of strength in the shoulders
- Bump on top of the shoulder
- Compromised shoulder motion
- Catching sound when the shoulders are moved
Patients recover rather quickly from an acromioplasty, so much so that they rarely require the use of slings. The average recovery period is around six weeks if the procedure is done in a minimally invasive manner. For an open surgery, recovery may take around 6 months to one year.
During the recovery period, patients are generally asked to simply rest the shoulder for the first few days after the procedure. However, to regain shoulder strength, speed up recovery, and decrease the risk of complications, patients are advised to begin physiotherapy as soon as possible.
How Does the Procedure Work?
As the term “subacromial decompression” suggests, an acromioplasty is performed by shaving the surface under the acromion to give it enough space to move around without hitting the tendons. This completely relieves the pain and other symptoms of the injury.
The procedure is typically performed using minimally invasive keyhole or arthroscopic surgery, wherein an arthroscope is used to take images of the interior of the shoulder to guide the surgeon during the surgery. To begin the procedure, the surgeon positions the patient in a supine posture with the right shoulder elevated. He then makes a superior strap incision over the central part of the acromion’s anterior tip. Once the incision is made, the surgeon proceeds by detaching some fibers to access the affected area and then performs the necessary step to reduce the size of the acromion. He also inspects the rotator cuff tendons for some damage, which can be repaired during the same procedure. The surgical site is then covered with a dressing.
Possible Risks and Complications
Although the success rate of subacromial decompression procedure is very high, it places the patient at risk of the following complications:
- Excessive or prolonged bleeding
- Delayed healing of the wound
- Joint stiffness
- Blood vessel injury
- Nerve injury
- Post-surgical pain
- DeBerardino TM, Scordino L. Shoulder arthroscopy. In: Miller MD, Thompson SR, eds. DeLee and Drez’s Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 45.
- Phillips BB. Arthroscopy of the upper extremity. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 52.