“Shoulder arthroscopy and decompression” is the procedure which is performed to treat shoulder impingement. In shoulder impingement, the rotator cuff muscles are trapped (pinched) and compressed by the surrounding structures of the shoulder during the movement. According to the Journal of Knee Surgery, Sports Traumatology, Arthroscopy, 20% of all disability related musculoskeletal problem are associated to shoulder impingement.
Shoulder impingement is the common reason for shoulder pain, which is mostly seen in the aging adults. It is one of the common causes of shoulder pain that limits the range of motions. The patients feel difficulty in raising the arms, and sleeping on the affected side. Shoulder arthroscopy and decompression are done to decompress the rotator cuff muscle, which helps the patients to come back to the normal condition.
Before starting the impinged shoulder, the doctor takes a radiography, X-ray, thorough history and does the physical examination to evaluate if the pain is related to the other part of your body.
Usually, non-surgical treatments like physiotherapy, activity modification, rehabilitation, and certain anti-inflammatory medication work well in shoulder impingement. A cortisone injection is also effective in more than 85% of the patients with a shoulder impingement, which reduces the symptoms within 3-6 months.
Your doctor may suggest you the surgery if the non-surgical treatment fails to cure the problem. Depending upon the suitability, the doctor may perform the procedure either arthroscopically or as an open surgery. Nowadays, more than 90% cases of shoulder impingements are treated successfully by the arthroscopic approach.
About the arthroscopy and decompression:
Arthroscopic (Subacromial) decompression procedure requires 3 cuts (incision) under the anesthesia. Then, the arthroscope is inserted into the shoulder through the skin and a muscle called deltoid. Your health care provider then performs an inspection with the help of the arthroscope, to check the tears of the ligaments, tendons, muscles, and if there is any loose body. After that, the doctor assesses the overall joint surface.
Steps of the procedure:
- Use of fluid pump: The surgeon inserts a metallic tube through one of the incisions. The tube is inserted to expand the joint by pumping the fluids inside. It helps the surgeon to create space so that he can have visual access and perform the procedure properly.
- Insertion of the Arthroscope: Arthroscope is inserted after examining the joint, which should be placed on the space present above the rotator cuff. The surgeon smoothens the spike or spur of the space that contributes to the impingement and inflammation of the rotator cuff muscles.
- Removal of the inflamed bursa: swollen or inflamed bursa is removed by using the arthroscope.
- Cutting the Ligament: Sometimes the ligament called coracoacromial impinges on the rotator cuff muscles which cause pain in the shoulder. So, another instrument is inserted through the 3rd incision to remove the ligament.
- Shaping the bone: The part of the acromion bone, which gets hooked, is smoothened and shaved. It clears the area above the tendon called supraspinatus tendon and takes the strain off the rotator muscle.
- At the End of the Procedure, the fluids that were pumped inside the joint are drained out, all the tools should be removed, and lastly, the cuts are sutured and bandaged.
The benefits of the procedure:
- Allows shorter recovery period.
- It causes less pain as compared to the open surgery.
Risks after surgery:
As compared to the other surgeries, the risks, and complications related to shoulder arthroscopy and decompression are very low, and seen in a few patients. Some of the common risks are:
- Problem in wound healing
- Injury to the nerves, vessels, and the joint surface.
- Stiffness or frozen shoulder
Patient’s preparation for surgery:
- Before undergoing the procedure, you should be well-informed about the surgery. Do not keep any doubt in mind. Ask your doctor about all the pros and cons of the surgery. Take few more opinions if necessary.
- Finish all the tests advised by your doctor before the surgery.
- Do not consume Aspirin or any non-steroidal anti-inflammatory medications one week before the surgery.
- Get the surgery done by an experienced and skilled orthopedic professional.
- Keep your shoulder joint flexible as much as you can. If it is very painful, then you can take medication, ice or heat therapy, and also seek help from a physiotherapist.
- It is an outpatient procedure, so the patients are mostly discharged on the same day. Your doctor may ask you to have physiotherapy to restore the normal range of motion of the shoulder. You should follow the exercise and stretches prescribed by your surgeon without any fail, which can help you come back to the normal life within a short span of time.
- Your doctor would also prescribe some painkiller for pain relief.
- A sling or splint is used to place your arm for the first few days.
Recovery period after surgery:
The recovery period depends on the individual. Usually, the patient of shoulder arthroscopy requires from 1 week to 3 months to return to the normal life. About 95% of the patient starts to strengthen their shoulder at the end of the 6 weeks. However, the overall recovery period is three to six months. Some may take more time.
Rehab after surgery:
- Rehabilitation after shoulder and decompression is mandatory. Your therapist will teach you the exercises, which can help you avoid the swelling, pain and stiffness.
- Keep moving your fingers, elbow and hands.
- Do not lift heavy object during the healing period, because it can cause muscle strain and delay the healing.
Management at home after surgery:
Mostly the patients can do the small things like eating, dressing, handling books, and other light objects within the 2-4 days. The patients should keep the operated area dry while taking the shower. Do not do any activity like driving vehicle and all unless you are completely fit and fine.
Shoulder arthroscopy and decompression is the ultimate treatment option if the other treatment does not work. According to the various researches made on the outcome of the procedure, it is estimated that the patients’ satisfaction is more than 90% with comfortable shoulder function of at least for 8-11 years after the procedure.
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