Subacromial Decompression Protocols

After all conservative therapies have failed, subacromial decompression surgery is often performed for shoulder impingement syndrome, which is commonly caused by sports injuries. Pressure of the scapula on the rotator cuff results in shoulder pain and dysfunction. Subacromial decompression surgery is done arthroscopically with a minimally invasive approach. Surgeons use a small scope to examine and repair damage to the inside of the joint.

The Procedure

• The surgeon makes three tiny incisions and inserts a camera and other small instruments into the joint. After a thorough examination of the shoulder, the surgeon completely removes the subacromial bursa to alleviate inflammation, irritation and scar tissue. The surgeon then shaves the acromion to increase space for the rotator cuff tendons. Next, the surgeon removes any scar tissue from the coracoacromial ligament. Any tears on the rotator cuff are repaired at this time. The surgeon removes the camera and instruments, then closes the incisions with staples or sutures.

Symptom Relief

• Immediately after surgery, the patient should ice the shoulder as much as possible. Surgeons recommend using ice every three to four hours during the day. The patient will be given a sling in the hospital, which he should continue to use for five to 10 days, and may also be given an electrical stimulation unit to be used as directed by the surgical team.

Wound Care

• The patient should expect to see a small amount of blood on the surgical dressing; however, if the bandage becomes soaked, he should contact the surgical team. Dressings are to be changed according to the surgeon's recommendations. The patient may shower when surgical wounds have healed, with surgeons recommending sponge baths until that time. The patient should not touch the incisions or apply any substance to them until he has approval from the surgeon.

Rehabilitation

• Rehabilitation protocols vary depending on the condition of the shoulder. During the first one to two weeks following surgery, the patient participates in passive range of motion exercises, which a physical therapist performs with no assistance from the patient. At approximately two weeks following surgery, the patient continues with passive range of motion and adds active assisted range of motion, an exercise regimen performed by the patient and assisted by physical therapist. At approximately three weeks post surgery, the patient moves to active range of motion exercises that he performs on his own. Patients are also asked to do pendulum exercises and shoulder rolls. Patients typically gain full function of the shoulder in approximately four to six weeks, though this varies by patient.

Activity

• The healing shoulder is not used for any reaching or grasping immediately following surgery. The patient must not support any amount of body weight until receiving clearance from the surgeon, typically in two to four weeks. Before the patient returns to normal activity, the surgeon must assess and confirm that adequate strength, flexibility and endurance have returned. The patient is not to drive until receiving clearance from his surgeon, typically after a week; however, if the patient is taking narcotic medications or muscle relaxants, driving is strictly forbidden. The patient who works a desk job can return to work after about a week, with a lifting restriction over five to 10 pounds. In addition, the patient is restricted from pushing, pulling, carrying or reaching above shoulder height until he has clearance from the surgeon. Surgeons generally allow patients to resume heavy lifting and reaching above the shoulder after one to two months. No sports activities are recommended for two to three months.