The Procedure
An acromioplasty involves shaving the under-surface of the acromion. The acromion is a projection of bone extending from the shoulder blade, over the top of the shoulder joint and provides attachment for muscles around the shoulder including the trapezius and deltoid muscles.
An acromioplasty is typically performed for patients where their rotator cuff is pinching on the under-surface of the acromion and the coracoacromial ligament when they lift their arm up to the side. The procedure is performed arthroscopically (i.e., keyhole surgery). If enough room is created, then the rotator cuff tendons may not pinch on the under-surface of the acromion and the pain of impingement can be completely relieved.
I recommend that we treat shoulder impingement with Physio Rehab and cortisone injections to the subacromial bursa. In my opinion, this conservative management is better than surgery for most people. It is rare that I recommend acromioplasty surgery for shoulder impingement and generally I only do so in severe recalcitrant cases.
I much more commonly perform an acromioplasty as part of the treatment for another shoulder condition, such asa rotator cuff tear or calcific tendinitis.
Pre Op
Whilst you wait for your surgery date, there are a few things to do:
- Speak to your health fund to confirm if the hospital fee for your surgery is covered on your policy
- Speak to your anaesthetist to confirm their fees
- Register your details with the hospital
- Read through, complete and return your paperwork to our office
- Plan your transport to and from the hospital. You won’t be able to drive yourself home after thesurgery, so make sure you have a travel plan in place
- If required, arrange any recommended pre op physio appointments
- If required, get any pre op pathology tests (e.g., blood tests)
- Use benzoyl peroxide5% wash on your shoulder for 5 applications: twice a day for two days, and thenagain on the morning of the surgery. This will help reduce your risk ofinfection from Cutibacterium acnes.
- Pack a bag for your hospital stay including regular medications in the original packaging, a loose button-up shirt to wear after surgery, nightwear, personal items including toiletries. If you have sleep apnoea, you must bring your CPAP machine
- If you are on any blood thinners, ring my office and confirm when to stop taking them before the operation.
- If you are on any diabetic tablet medications, ring your anaesthetist and confirm whether you need to stop taking them before the operation
- Confirm your admission details with my office one to two business days prior to surgery
Though this can seem overwhelming, you will be provided with detailed instructions on what needs to be done so your surgery journey can be as smooth as possible.
Complications
General risks of surgery include:
- Bruising & haematoma: this will vary for each patient. Bruising is a normal side effect of surgery and usually resolves in a short time. Haematoma may require a return to theatre for drainage.
- Infection: infection is a rare but possible risk and is usually treated with antibiotics.
- DVT and PE: deep vein thrombosis and pulmonary embolism are blood clots that form in either the lower limbs or lungs. If left untreated, DVT and PE can have serious effects, however if treated promptly, the risks are significantly lowered. More information can be found here.
- Anaesthetic risks: general anaesthetic (GA) carries a number of risks, which will be discussed in detail with your anaesthetist prior to surgery. Fortunately, Australia is one of the safest places to undergo a GA. In Australia, the risk of mortality from GA is around 1in 100,000. For context, the risk of death in a car accident in Queensland is around 1 in 10,000 per year.
- Wound issues: some superficial issues can develop in surgical wounds postoperatively, however most will require a small intervention to resolve the problem.
Risks and complications specific to Acromioplasty include:
- Frozen shoulder: around 3% of patients can develop frozen shoulder. It resolves with time. You will still get a good result from the surgery once the frozen shoulder has resolved, however it can make the rehab prolonged and miserable if the frozen shoulder is severe.
- Instability after acromioplasty surgery is rare and is more commonly an issue of misdiagnosis. What I mean by misdiagnosis is that the patient had instability in the first place which was mistakenly diagnosed as impingement. This happens because sometimes the symptoms of instability mimic those of impingement.
Day of Surgery
Your admission details will be confirmed one to two business days prior to surgery. You will need to make note of your admission time and your fasting time. Your admission time may be as early as 6am. If you aren’t local toBrisbane, it is usually recommended that you stay the night before in case your admission is early.
When you arrive at the hospital, you will go through the admissions process and then be taken through to the surgical waiting area. Your anaesthetist will have a short consultation with you before you go into theatre and under general anaesthetic. I will say hi to you before the surgery in the anaesthetic bay of the operating theatre and mark your operation site with you.
Your hospital stay will usually be one night.You will be discharged usually after 10am. I will see you before your discharge. I will provide you with a folder containing a detailed postoperative pack including a letter telling you what I found at surgery and exactly what Idid in your operation along with information about your rehabilitation and postoperative care. Remember to have someone available to take you home from the hospital.
Post Op Recovery & Healing
The post-operative recovery for an acromioplasty is typically rapid. A sling is not required, but it can be used to rest the shoulder following the operation for the first few days.
Physiotherapy is started immediately after the procedure, and it will take 3 to 6 months of rehab following surgery before your shoulder makes a full recovery. Patients will usually need around two weeks of rest and no driving, so this will need to be considered when planning surgery.
Rehabilitation
After acromioplasty, rehabilitation and physiotherapy exercises aim to improve shoulder mobility and strength.
Physiotherapy Guidelines
Day 1 Physio Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling. Please make sure you go through these things with the physio so that you get them really clear in your mind before you leave hospital.
Goal:
- Promotion of gentle function and restoration of passive and active shoulder range of motion
Day One:
- Education and Reassurance: no surgical repair, ok to start moving, will not “pull anything apart”
- Sling: for comfort only, aim to cease wearing within a week, check fit, demonstrate activities of daily living (showering, dressing etc)
- ADL’s (activities of daily living): good to use the arm for light activities eg dressing/eating, function within pain limits.No repetitive or loaded work above chest height.
- Pain relief: ice, positioning, posture, pain medications as prescribed
- AAROM (active-assisted range of motion)exercises: no limitation in range, move into all directions as able, focus initially on flexion and external rotation, possible exercises include:
- Circular pendulum
- AA (active-assisted) external rotation at neutral
- Supine flexion
- Forward lean on bench
- Horizontal flexion
- Supine Hand to head
- Internal rotation - hand to hip with neutral scapula
- Patient may refer to Extend Rehab or DrCutbush's website for exercise videos
Follow up:
With local physiotherapist week 2 to check AROM(active range of motion) and PROM (passive range of motion) improving. Week 6 postop consultation with Dr Cutbush and Extend Shoulder Physiotherapist. Your post op consultations can be either in person or by a telehealth video consultation (Facetime or WhatsApp), just let my office know which works for you.
Results After Surgery
Acromioplasty typically yields positive results, with most patients experiencing a very significant reduction in their pain and improved range of motion within several months following surgery. Long term, results remain beneficial, with a high level of improved shoulder function reported in acromioplasty patients. Keep in mind, all shoulder rehab is much slower than most people would like it to be. Rehab often takes at least 4months following an acromioplasty. It’s not uncommon for the shoulder to ache for some time after the surgery.