Shoulder Bursitis Surgery

Subacromial Decompression for Treatment of Shoulder Iflammation

arthroscopy
Using small instruments and a camera, your surgeon can look inside joints. John Kelly / Getty Images

Shoulder bursitis is the most common cause of shoulder pain.  Also called rotator cuff tendonitis or impingement syndrome, this condition causes inflammation and pain with movement of the shoulder.  Patients often report discomfort over the outside of the arm, pain with lifting, and discomfort when trying to sleep at night.  It is important to distinguish shoulder bursitis from other common causes of shoulder pain such as a rotator cuff tear or frozen shoulder.

Once a diagnosis of shoulder bursitis has been made, simple treatments should be tried first.  The vast majority of patients can find relief of pain with nonsurgical treatments including physical therapy, rest, anti-inflammatory medications, and cortisone injections.  If the treatments have been tried for at least 3 to 6 months without improvement in symptoms, a surgical procedure called a subacromial decompression may be considered.

Subacromial Decompression Surgery

The procedure used in the treatment of shoulder bursitis is called a subacromial decompression. This is an arthroscopic surgery performed using instruments inserted through small incisions. Depending on the location of the inflammation and the extent of work that needs to be done, usually two to four small (1 centimeter) incisions are made.  A small tube called a cannula is inserted into each incision to allow easy passage of instruments in and out of the shoulder without damaging the surrounding tissues.

  One of the instruments inserted into the shoulder is a video camera about the size of a pencil. Another instrument called a shaver is inserted through another cannula. 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.

The bone above the rotator cuff (the point of the shoulder) is called the acromion.  Many people with bursitis of the shoulder have a bone spur that forms on the undersurface of the acromion.  Depending on the bone of the acromion, a burr may be used to remove the spur to create more space for the rotator cuff tendons.  The benefit of removing the bone spur is a subject of debate among orthopedic surgeons.  Some surgeons believe the spur is a major cause of inflammation by taking up space around the rotator cuff tendons, while others contend that removing the bone spur has never been shown to improve the results of patients who have this surgery.

Post-Surgical Rehab

Patients are placed in a shoulder sling following subacromial decompression, but they can begin shoulder motion quickly. Unlike surgery for a rotator cuff tear, there is no need for a period of restricted motion to allow for tendon healing. In cases of an isolated subacromial decompression, patients can begin gentle motion immediately after surgery.

Strengthening can begin within a few weeks, and sports can resume after the swelling has subsided.

Because a subacromial decompression is often a part of another surgical procedure (such as a rotator cuff repair or labral repair surgery), the rehab may be very different under these circumstances.  Therefore any patient should discuss their rehab progression with their own surgeon.

Complications of Shoulder Arthroscopy

Complications after subacromial decompression are uncommon, but can occur.  The most common problems are pain and stiffness, that usually resolve with physical therapy and time.  However, there are more serious complications including infection, nerve injury, and cartilage damage, all of which can cause long-term problems.  It is important to take steps to prevent these complications to ensure the best possible result of surgery.

Sources:

Bigliani LU, Levine WN. "Subacromial impingement syndrome" J Bone Joint Surg Am. 1997 Dec;79(12):1854-68.

Izquierdo R, et al. "Arthroscopic acromioplasty" Instr Course Lect. 2004;53:13-20.

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