Performed by – Ankit Desai, Gareth Hill, Philip Rosell

This operation is typically performed for subacromial pain or rotator cuff issues that cause pain in the shoulder. In most instances, the pain is related to movement of the shoulder, particularly when the hand is raised above shoulder height.

Subacromial pain syndrome is frequently related to sport, especially swimming and racquet sports, but also domestic tasks and gardening. Pain commonly affects routine daily tasks such sleeping and dressing.

The pain is related to four tendons that move the shoulder. These tendons are collectively called the rotator cuff. They are attached to the shoulder blade at one end and to the top of the humerus (upper arm) at the other. The tendons pass through a narrow space just before attaching to the top of the humerus. There are many reasons why either the rotator cuff, ligaments or the fluid filled sac (Bursa) can become painful. This includes age related changes, muscle imbalance, overuse as well as occasional bony spikes that can put additional pressure on the tendons.

It is usually beneficial to obtain simple imaging such as an X-ray but depending on your history and symptoms, further imaging in the form of either an Ultrasound or MRI may be suggested to confirm your diagnosis and help guide management.

Non-operative management
The initial treatment is usually rest, avoiding any activities that exacerbate the pain and the use of simple painkillers and physiotherapy. Current evidence would suggest a simple exercise programme will provide benefits within 6-12 weeks If the pain persists a steroid injection may then be recommended to help you undertake physiotherapy. Steroid injections alone without physiotherapy are unlikely to provide lasting benefit.

We would advise reviewing the British Shoulder and Elbow Society website that has provided good information and videos: Subacromial Shoulder Pain – British Elbow & Shoulder Society https://bess.ac.uk/subacromial-pain/.

Operative management
In small proportion of patients who do not improve with non-operative management, surgery may be indicated.

The operation is carried out under a general anaesthetic and usually is performed as a day case. The procedure is performed using small incisions through which an arthroscope (telescope) and small instruments can be passed. These instruments are used to remove bony spikes, release tightened ligaments and increase the space through which the rotator cuff tendons pass. It also provides an opportunity to assess the joint completely to ensure there are no other causes of your ongoing pain and if possible address them at the same time.

The small wounds are closed with stitches or steristrips and your arm will be placed in a sling.

What happens after surgery?
Following surgery, exercises are started immediately to regain function in the arm. Physiotherapy is generally started after 2-3 weeks.

It will take between 3 weeks to 3 months for the shoulder pain to settle and function can continue to improve for 6 or 9 months after surgery.

You will need 2 weeks off work after surgery and longer if you have a manual or physical job. You should be able to drive after 3-4 weeks on average and we advise gradually returning to sport as comfort permits.

About 90% of people who undergo a subacromial decompression find their pain and movement greatly improved by the surgery after completing the rehabilitation.