An acromioplasty shaves the underside of the acromion, the bony projection from the shoulder blade that arches over the shoulder joint and gives attachment to muscles including the trapezius and deltoid.
It is performed when the rotator cuff catches on the under surface of the acromion and the coraco-acromial ligament as the arm is lifted out to the side. Creating more space in that gap can stop the pinching and relieve impingement pain.
When this operation is, and isn’t, recommended
Physiotherapy and cortisone injection into the subacromial bursa are recommended first for shoulder impingement, and for most people those work better than surgery. Dr Cutbush rarely recommends acromioplasty on its own for impingement; it is generally reserved for severe cases that have not responded to other treatment.
More often, an acromioplasty is performed as part of treating another condition, for example alongside a rotator cuff repair or an excision of calcium.
The procedure
The surgery is arthroscopic, performed through small keyhole incisions. The under surface of the acromion is shaved back and the coraco-acromial ligament released, which increases the space available to the rotator cuff tendons. The subacromial bursa is usually excised at the same time.
Risks and complications
Every operation carries risk. These are the ones discussed in consultation.
General surgical risks
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Bruising and haematoma. Bruising is normal and settles quickly. A haematoma may occasionally need a return to theatre for drainage.
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Infection. Uncommon, and usually treated with antibiotics.
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DVT and pulmonary embolism. Blood clots in the legs or lungs. Untreated these can be serious, but recognised and treated promptly the risk of serious consequences is greatly reduced.
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Anaesthetic risks. Discussed in detail with your anaesthetist beforehand. Mortality from general anaesthesia in Australia is in the order of 1 in 100,000.
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Wound problems. Usually superficial, and generally needing only a minor intervention.
Risks specific to acromioplasty
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Frozen shoulder. Around 3% of patients. It resolves with time and the final result is still good, but where it is severe it can make rehabilitation long and difficult.
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Instability. Rare, and more often a question of diagnosis: existing instability can be mistaken for impingement because the symptoms overlap.
Before surgery
- Confirm with your health fund that the hospital fee is covered by your policy.
- Confirm your anaesthetist’s fees.
- Register your details with the hospital.
- Read, complete and return the paperwork to the office.
- Plan transport to and from hospital. You cannot drive yourself home.
- Arrange any recommended pre-operative physiotherapy, and complete any required pathology such as blood tests.
- Apply benzoyl peroxide 5% wash to the shoulder five times in total: twice daily for two days, then once on the morning of surgery. This reduces the risk of infection from Cutibacterium acnes.
- Pack your regular medications in their original packaging, a loose button-up shirt, nightwear and toiletries. Bring your CPAP machine if you have sleep apnoea.
- Ring the office to confirm when to stop any blood thinners, and ring your anaesthetist about diabetic tablets.
- Confirm admission details with the office one to two business days beforehand.
You will be given detailed written instructions to help the process run smoothly.
The day of surgery
Admission is confirmed one to two business days beforehand. Note both your admission time and your fasting time. Admission can be as early as 6am, so if you live outside Brisbane it is usually best to stay nearby the night before. See accommodation options.
After completing admission you will wait in the surgical waiting area. The anaesthetist will consult with you before you go through to theatre. Dr Cutbush will greet you in the anaesthetic bay and mark the operation site with you.
The stay is usually one night, with discharge typically after 10am following a review with Dr Cutbush. You will be given a folder containing a letter describing what was found and done during surgery, along with rehabilitation and aftercare information. Arrange for someone to take you home.
Recovery and healing
Recovery after an acromioplasty is usually rapid. Because nothing has been repaired, a sling is not required, although you may want to use one for the first few days to rest the shoulder.
Physiotherapy starts immediately after surgery. Most people need about two weeks of rest and must not drive during that time, so plan accordingly. Full recovery takes three to six months of rehabilitation.
Rehabilitation
Rehabilitation aims to restore shoulder mobility and then strength.
Day one
The hospital physiotherapist will show you how to fit the sling and how to manage eating, showering and dressing. Make sure these are clear before you leave hospital.
The important point to understand is that no surgical repair has been performed. It is safe to move the shoulder. You will not pull anything apart. The goal from day one is gentle function and restoring both passive and active range of motion.
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Sling. For comfort only. Aim to stop wearing it within a week.
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Daily activities. Light use of the arm for dressing and eating is fine, within the limits of pain. Avoid repetitive or loaded work above chest height.
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Pain relief. Ice, positioning, posture and the medication you have been prescribed.
Active-assisted range of motion exercises
There are no range limits. Move in all directions as able, starting with flexion and external rotation:
- Circular pendulum
- Active-assisted external rotation at neutral
- Supine flexion
- Forward lean on a bench
- Horizontal flexion
- Supine hand to head
- Internal rotation, hand to hip with neutral scapula
Follow-up
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Week 2. Your local physiotherapist checks that active and passive range of motion are improving.
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Week 6. Post-operative consultation with Dr Cutbush and the Extend shoulder physiotherapist. This can be in person or by video; let the office know your preference.
Results after surgery
Most people experience a significant reduction in pain and improved range of motion within several months, and reported improvement in shoulder function is maintained over the longer term.
It is worth setting expectations on timing: rehabilitation is slower than most people expect, often taking at least four months, and some ongoing aching for a while after surgery is common and not a sign that anything is wrong.
Next steps
This page is general information about a surgical procedure and is not a recommendation that you have it. Whether surgery is appropriate for you can only be determined after assessment. All surgery carries risk; the risks relevant to you are discussed in consultation before any decision is made.
