What does surgery involve?

On the day of surgery you will be admitted to the ward or surgical admission area. You will once again meet Mr Moverley who will ensure you are still happy to proceed and that you understand the risks and benefits of the procedure. This is a good opportunity for you to ask any further questions that you may have. You will be asked to sign a consent form if you have not already done so.

You will meet your anaesthetist who will explain the type of anaesthetic you will receive. Arthroscopic shoulder surgery usually requires a general anaesthetic (you will be asleep) and a nerve block so that the arm will be numb for approximately 12 hours post operation.

An arthroscopic subacromial decompression and/or ACJ Excision is performed as a ‘key-hole’ procedure through two or three 1cm incisions around your shoulder. Mr Moverley will be able to assess the inside of your shoulder in great detail using a high-resolution camera to establish the most likely causes of your symptoms.

Mr Moverley will then release any inflamed and contracted tissue as well as shaving away a small amount of  bone from the front of the acromion bone, to increase space for the tendons.

If the ACJ is also causing pain then approximately 5mm of bone will also be shaved from the end of the clavicle to decompress the joint and prevent the bones from rubbing on one another.

If the biceps tendon is thought to be a cause for your symptoms this is usually cut to remove it from the shoulder joint (this does not cause any long term weakness but you may notice a lump in the upper arm).

Occasionally other damage is found within the shoulder joint that requires repair.

At the end of the procedure Mr Moverley will gently stretch the shoulder in all directions to ensure a full range of motion can be achieved.

The procedure is usually done as a day case meaning you can go home on the same day as your surgery.

The small wounds are repaired with stitches and covered with a splash proof dressing. The wounds should be kept dry for 10-14 days.

What happens post operatively?

Immediately after surgery your arm will be in a sling and will usually feel heavy and numb as a result of the nerve block. You will be given painkillers if you are in any pain, and these will also be provided upon discharge.

A physiotherapist will assess you to make sure that you can remove and apply the sling safely. They will provide some early exercises to help prevent stiffness of the hand, wrist and shoulder.

Physiotherapy is individualised to your specific needs and will progress with the following goals:

• Early (1-2 weeks): Minimize post-operative stiffness with active finger, wrist and elbow movements. Wean off the sling after 2 days. Shoulder pendulum exercises progressing to full active range of movement as pain allows. Posterior capsule stretching exercises.

• Middle (2-6 weeks): Continue to achieve full active range of movement. Isometric rotator cuff stretching to treat tendinitis.

• Late (6 weeks and beyond): Strengthening program, once full range has been achieved. Graded return to all previous functional and recreation activities.

Approximately how long will it be before I can…?

• Drive 2 weeks

• Desk job 2 weeks

• Manual work 8-12 weeks

• Golf 12 weeks

• Racket sport 12 weeks

• Contact sport 12 weeks

• Repetitive overhead activity/sport 12 weeks

Pain can persist for 6 months post surgery, especially if the ACJ has been excised

What are the potential risks and complications?

As with any operation, a small number of people may have problems after an arthroscopic subacromial decompression and/or ACJ Excision. Most of these problems are quite minor and can be treated easily but occasionally further surgery is needed.

 Potential risks and complications are:

• Infection – less than 1 % of cases

• Stiffness - Mild stiffness is quite common but occasionally a full frozen shoulder can occur (5% of cases) which can prolong your recovery by a few months, it usually responds well to a steroid injection.

• Failure to improve (10-15% of cases)

Is arthroscopic subacromial decompression and/or ACJ Excision always successful?

Approximately 85% of patients will make a good or excellent recovery. 15% will have a degree of discomfort but will be satisfied with their outcome. 5% of patients will have on-going problems, such as pain and stiffness, and some of these require further surgery.

The results of arthroscopic subacromial decompression and/or ACJ Excision are therefore not guaranteed which is why Mr Moverley will want to ensure that all non-operative measures have been exhausted first.