Subacromial smoothing and acromioplasty for rotator cuff disorders

Surgery Overview

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Surgery may be used to treat a rotator cuff disorder if the injury is very severe or if nonsurgical treatment has failed to improve shoulder strength and movement sufficiently. Subacromial smoothing involves shaving bone or removing growths on the upper point of the shoulder blade. It removes scar tissue and damaged tendon and bursa from the joint. The surgeon may also remove small amounts of bone from the underside of the acromion and the acromioclavicular joint (acromioplasty). The goal is to eliminate roughness while retaining as much of the normal supporting structures as possible. This surgery creates more room in the subacromial space so that the rotator cuff tendon is not pinched or irritated and can glide smoothly beneath the acromion.

Subacromial smoothing, acromioplasty, and rotator cuff repair may be done using arthroscopic surgery or open surgery.

• Open-shoulder surgery involves making a larger incision in the shoulder, to open it and directly view the repair.
• Arthroscopy uses a thin viewing scope called an arthroscope that is inserted into a joint through a small incision in the skin. Then the surgeon will remove loose fragments of tendon and bursa and other debris from inside the irritated, injured, or torn area of the subacromial space (debridement). Additional instruments are then arthroscopically inserted to shave the bone or remove growths. This type of surgery is done on an outpatient basis.

You probably will have general anesthesia during arthroscopy. Occasionally, people have a regional nerve block, either alone or with general anesthesia.

• If a nerve block alone is done, you may be awake. You will not feel any pain; however, you may feel a sensation of pulling or tugging during the procedure.
• Regional nerve blocks are sometimes used in addition to general anesthesia to help manage pain after surgery.

What To Expect After Surgery

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You may go home a few hours after waking up from anesthesia. A family member or friend should drive you home. However, you may stay overnight for help with pain management and for observation.

Discomfort after surgery may be relieved by:

• Applying ice to the surgical site 3 times a day.
• Taking pain medications as prescribed.
• Immobilizing and protecting the shoulder by wearing a sling as directed. Your health professional will advise you whether you need a sling after surgery. Some health professionals do not recommend this, because the shoulder joint may become stiff.

With a doctor's approval, you may be able to return to light work within a few days after surgery even if you are using a sling.

Physical therapy after surgery is crucial for a successful recovery. A typical rehabilitation schedule includes the following:

• Active range-of-motion exercises may start the day after subacromial smoothing surgery.
• Strength training may begin several weeks after arthroscopic surgery.

Once normal shoulder strength and range of motion return, usually after about 6 to 8 weeks, you can gradually resume playing sports.

Why It Is Done

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Smoothing may be done for people who:

• Have severe pain, catching or locking of the shoulder, and impaired shoulder function that has not responded to a few months of conservative treatment.
• Are over 60 years old with complete tears and whose main problem is pain, not weakness.
• Do not wish to have more extensive surgery to repair a rotator cuff tear.

In addition, if you have a rotator cuff tear, you may have arthroscopic smoothing before open surgery.

How Well It Works

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Most people who have smoothing to treat subacromial roughness are satisfied with the results.

Risks

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In addition to the general risks of surgery, such as blood loss or problems related to anesthesia, complications of subacromial smoothing surgery for rotator cuff disorders may include:

• Nerve damage.
• Stiffness.
• Infection.

Subacromial smoothing does not always correct the rotator cuff problem. Factors that may cause the surgery to fail include:

• Persistent stiffness.
• An incorrect diagnosis—the cause of the problem is not what was expected.
• Fractures on the upper edge of the shoulder blade (acromion) caused by shaving off too much bone during surgery and weakening it.
• Roughness that persists because the surgery doesn't smooth the acromion sufficiently.
• Burning pain, tenderness, and swelling in the hand or other extremities, a condition called reflex sympathetic dystrophy.

What To Think About

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Subacromial smoothing using arthroscopic surgery can improve shoulder function without some of the drawbacks of open surgery. The benefits of needing only arthroscopic surgery for subacromial smoothing rather than open surgery include:

• A significantly shorter recovery time.
• A shorter hospital stay that may result in less expense.
• Keeping the deltoid muscle attached, which aids rehabilitation.
• The surgeon's ability to inspect and debride both surfaces of the rotator cuff, rather than just the outside.
• Detecting other damage to the inside of the shoulder joint.

If repair of the rotator cuff tendon is necessary, more extensive open surgery for repair may be needed.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Other Works Consulted

• Devinney DS, et al. (2005). Surgery of shoulder arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp. 995–1015. Philadelphia: Lippincott Williams and Wilkins.

• Husni EM, Donohue JP (2005). Painful shoulder and reflex sympathetic dystrophy syndrome. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 2, pp. 2133–2151. Philadelphia: Lippincott Williams and Wilkins.

• Krishnan SG, Hawkins RJ (2003). Rotator cuff and impingement lesions in adult and adolescent athletes. In JC DeLee, D Drez Jr., eds., DeLee and Drez's Orthopaedic Sports Medicine, Principles and Practice, 2nd ed., vol. 1, pp. 1065–1095. Philadelphia: W.B. Saunders.

• Speed C, Hazleman B (2005). Shoulder pain. Clinical Evidence (13):1555–1571.

Credits

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Author	Colleen Cronin
Author	Lila Havens
Editor	Katy E. Magee, MA
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Kathie Hummel-Berry, PT, PhD - Physical Therapy
Last Updated	February 10, 2006