Acromioplasty: Understanding This Shoulder Impingement Surgery

What is Acromioplasty Surgery?

Acromioplasty is a surgical procedure designed to widen the subacromial space in the shoulder, typically performed to relieve impingement symptoms by removing a portion of the acromion bone and often inflamed bursa.

Understanding Shoulder Anatomy

To grasp acromioplasty, it's essential to understand the key anatomical structures of the shoulder joint. The shoulder is a complex ball-and-socket joint formed by three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone).

• Acromion: A bony projection extending from the scapula, forming the "roof" over the humeral head.
• Rotator Cuff: A group of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) and their tendons that surround the shoulder joint, providing stability and enabling a wide range of motion.
• Subacromial Space: The narrow space between the acromion and the rotator cuff tendons.
• Subacromial Bursa: A fluid-filled sac located within the subacromial space, which reduces friction between the acromion and the rotator cuff tendons.

When the rotator cuff tendons or the bursa become inflamed or swollen, they can become compressed or "impinged" against the acromion, especially during arm elevation. This condition is known as subacromial impingement syndrome.

What is Acromioplasty?

Acromioplasty, also known as subacromial decompression, is a surgical procedure primarily aimed at increasing the space available for the rotator cuff tendons and the subacromial bursa. The core of the procedure involves removing a small portion of the underside of the acromion bone, often along with any bone spurs (osteophytes) that may have formed. The inflamed subacromial bursa is also frequently removed (bursectomy).

The goal is to alleviate the compression on the rotator cuff tendons and bursa, thereby reducing pain, improving range of motion, and preventing further damage to the tendons, such as tears.

Why is Acromioplasty Performed?

Acromioplasty is typically recommended when conservative treatments have failed to relieve symptoms of subacromial impingement syndrome or related conditions. These conditions include:

• Subacromial Impingement Syndrome: The most common indication, characterized by pain and weakness when lifting the arm, caused by the rotator cuff tendons rubbing against the acromion.
• Rotator Cuff Tendinopathy/Tendinitis: Inflammation and degeneration of the rotator cuff tendons, often secondary to chronic impingement.
• Subacromial Bursitis: Inflammation of the bursa, which can also contribute to or result from impingement.
• Bone Spurs: The presence of osteophytes on the underside of the acromion can further narrow the subacromial space.

The procedure aims to create a smoother, wider pathway for the rotator cuff tendons to glide without impingement, reducing pain and improving shoulder function.

The Surgical Procedure

Acromioplasty is most commonly performed using an arthroscopic technique, which is minimally invasive. In some cases, an open surgical approach may be necessary, though this is less common today.

• Arthroscopic Acromioplasty:

  • The surgeon makes several small incisions (typically 2-3) around the shoulder.
  • A small camera (arthroscope) is inserted through one incision, projecting images of the inside of the shoulder onto a monitor.
  • Tiny surgical instruments are inserted through the other incisions.
  • The surgeon identifies the subacromial space, removes any inflamed bursal tissue, and then uses a motorized burr to shave down the underside of the acromion and remove any bone spurs.
  • The incisions are then closed with sutures or sterile strips.
  • This approach offers benefits such as smaller scars, less post-operative pain, and faster recovery compared to open surgery.

• Open Acromioplasty:

  • This involves a larger incision (several inches) over the shoulder to directly visualize the structures.
  • The deltoid muscle may need to be detached and then reattached.
  • The bone is removed using traditional surgical instruments.
  • While less common for isolated acromioplasty, it may be used if other extensive repairs (e.g., large rotator cuff tear repair) are also necessary.

The procedure is typically performed under general anesthesia, sometimes with a regional nerve block to provide pain relief for several hours post-surgery.

Recovery and Rehabilitation

Recovery from acromioplasty is a gradual process that is highly dependent on diligent adherence to a prescribed rehabilitation program.

• Immediate Post-Op (Days 1-7):

  • Pain Management: Medications, ice packs.
  • Immobilization: A sling may be worn for comfort and protection, typically for a short period (e.g., 1-2 weeks).
  • Early Motion: Gentle passive range of motion exercises may begin under the guidance of a physical therapist to prevent stiffness.

• Phase 1: Protecting the Repair and Early Motion (Weeks 1-6):

  • Focus on reducing pain and inflammation.
  • Continue passive and assisted range of motion exercises.
  • Avoid active lifting or reaching overhead to protect healing tissues.

• Phase 2: Gradual Strengthening (Weeks 6-12):

  • Once sufficient pain control and range of motion are achieved, progressive strengthening exercises for the rotator cuff and scapular stabilizers are introduced.
  • Isometric exercises, light resistance bands, and gentle weight-bearing activities.

• Phase 3: Advanced Strengthening and Return to Activity (Weeks 12+):

  • Progression to more challenging resistance exercises, incorporating functional and sport-specific movements.
  • Return to daily activities, work, and recreational sports is gradually phased in, typically over 3 to 6 months, depending on the individual's progress and the demands of their activities.

Physical therapy is paramount for successful recovery, restoring strength, flexibility, and function to the shoulder. Without it, stiffness, weakness, and persistent pain are more likely outcomes.

Potential Risks and Complications

While generally safe and effective, like any surgical procedure, acromioplasty carries potential risks, including:

• Infection: At the incision sites or within the joint.
• Bleeding: Excessive bleeding during or after surgery.
• Nerve Damage: Temporary or permanent injury to nerves around the shoulder.
• Stiffness (Frozen Shoulder): Though a goal of the surgery is to improve motion, postoperative stiffness can occur.
• Persistent Pain: Despite the surgery, some individuals may continue to experience pain.
• Re-impingement: In rare cases, the bone may regrow or other factors can lead to a return of impingement symptoms.
• Anesthesia Risks: Adverse reactions to anesthesia.

Your surgeon will discuss these risks in detail and take precautions to minimize them.

When is Acromioplasty Considered?

Acromioplasty is typically considered only after a thorough evaluation and when a period of conservative, non-surgical treatment has failed to provide adequate relief. Conservative measures often include:

• Rest and activity modification.
• Ice and heat therapy.
• Anti-inflammatory medications (NSAIDs).
• Corticosteroid injections into the subacromial space.
• Physical therapy focused on improving posture, scapular mechanics, and rotator cuff strength and flexibility.

If these measures do not resolve symptoms after several months, and imaging studies (like MRI) confirm structural issues such as bone spurs or significant inflammation contributing to impingement, then acromioplasty may be a viable surgical option.

Conclusion

Acromioplasty is a common and often effective surgical procedure for individuals suffering from chronic subacromial impingement syndrome and related conditions. By widening the subacromial space, it aims to reduce pain, improve shoulder mechanics, and restore function. While the surgery itself is relatively straightforward, the success of the procedure hinges significantly on a dedicated and consistent rehabilitation program. As with any medical intervention, a thorough discussion with your orthopedic surgeon is crucial to understand if acromioplasty is the right treatment path for your specific condition, weighing its potential benefits against the inherent risks.