Subacromial smoothing and acromioplasty for rotator cuff disorders
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.
Signs and symptoms of a broken bone include:
Swelling or bruising over a bone.
Deformity of an arm or leg.
Pain in the injured area that gets worse when the area is moved or pressure is applied.
Loss of function in the injured area.
In open fractures, bone protruding from the skin.
Fractures are usually caused by a fall, blow, or other traumatic event.
Pathologic fractures are those caused by disease (such as cancer) that weakens the bones and can occur with little or no trauma...
Open-shoulder surgery involves making a larger
incision in the shoulder, to open it and directly view the
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.
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
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
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
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.
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
Roughness that persists because the surgery doesn't smooth the
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
A shorter recovery time.
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
Detecting other damage to the inside of the shoulder
Beasley VidalLS, 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
Primary Medical Reviewer
William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer
Patrick J. McMahon, MD - Orthopedic Surgery
January 7, 2010
WebMD Medical Reference from Healthwise
January 07, 2010
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