Surgery Overview
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 (acromion). It removes 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 take away roughness while keeping 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, bursa, and other debris from the
shoulder (debridement). Other instruments
are then arthroscopically inserted to shave the bone or remove growths. This
type of surgery is usually done on an outpatient basis.
You may have
general anesthesia during arthroscopy, or you may have
a regional
nerve block.
- If a nerve block alone is done, you may be
awake. You will not feel any pain, but 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
You may go home a few hours after waking up from anesthesia. A
family member or friend should drive you home. In some cases, the doctor may
suggest that you stay overnight for help with pain and for
observation.
Discomfort after surgery may be relieved by:
- Applying ice to the surgical site 3 times a
day.
- Taking pain medicines as prescribed.
- Immobilizing
and protecting your shoulder by wearing a sling as directed. Your doctor will advise you whether you need a sling after surgery. Some
doctors 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:
- Range-of-motion exercises may start the day
after subacromial smoothing surgery.
- Strength training may begin a few weeks after surgery.
When 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
Smoothing may be done for people who:
- Have severe pain and impaired shoulder function
that has not responded to a few months of conservative
treatment.
- Are over 60 years old with severe 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
Most people who have surgery to smooth the bones and create more
space for the rotator cuff usually have less pain with shoulder
movement.1
Risks
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:
- Persistent pain.
- Stiffness.
- Infection.
- Nerve or blood vessel injury.
Subacromial smoothing does not always correct the rotator cuff
problem. Things that may cause the surgery to fail include:
- Stiffness or a
frozen shoulder.
- 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.
What To Think About
Subacromial smoothing using
arthroscopic surgery can usually improve shoulder function
as well as open surgery can but without some of the drawbacks of open surgery. The benefits of needing only
arthroscopic surgery for subacromial smoothing rather than open surgery
include:
- A shorter recovery time.
- A shorter
hospital stay, which may cost less.
- 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.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
References
Citations
- Beasley Vidal LS, et al. (2007). Shoulder injuries. In
PJ McMahon, ed., Current Diagnosis and Treatment in Sports Medicine, pp. 118–145. New York: McGraw-Hill.
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.
- Lin KC, et al. (2010). Rotator cuff: 1. Impingement lesions in adult and adolescent athletes. In JC DeLee et al.,
eds., DeLee and Drez's Orthopaedic Sports Medicine, Principles and Practice, 3rd ed., vol. 1, pp. 986–1015. Philadelphia: Saunders Elsevier.
- Speed C (2006). Shoulder pain, search date February
2006. Online version of BMJ Clinical Evidence. Available
online: http://www.clinicalevidence.com.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | William M. Green, MD - Emergency Medicine |
|---|
| Specialist Medical Reviewer | Patrick J. McMahon, MD - Orthopedic Surgery |
|---|
| Last Revised | January 7, 2010 |
|---|
Beasley Vidal LS, et al. (2007). Shoulder injuries. In
PJ McMahon, ed., Current Diagnosis and Treatment in Sports Medicine, pp. 118–145. New York: McGraw-Hill.
Seton is proud to have four hospitals – the only hospitals in Central Texas - that have earned the Magnet designation, the highest award for nursing excellence given by the American Nurses Association.