The Procedure
Os acromiale surgery is a procedure to treat the os acromiale condition, where parts of the acromion (the top part of the shoulder blade) are separated and failing to fuse together, creating a separate piece of bone linked by cartilage. Usually, it is a harmless condition and is managed with conservative treatments like physiotherapy, however in some cases, it can cause pain and impingement, and impact on other parts of the shoulder such as the rotator cuff and tendons.
The surgery involves either fixation of the separated piece of bone with screws or anchors, or excision of the separated bone. The type of surgery is indicated by the type of os (either meso, meta, or pre), as well as other shoulder conditions.
The surgery is typically done arthroscopically, but can be performed in an open technique. I usually book about two hours of time in the operating theatre.
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.
- Infection: infection is a 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 1 in 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.
Specific risks of os acromiale surgery include:
- Weakness in the deltoid (especially following excision of the unfused bone)
- Persistent pain or discomfort
- Hardware issues where the bone is fixed with screws or other anchors
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 my office
- Plan your transport to and from the hospital. You won’t be able to drive yourself home after the surgery, 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 peroxide 5% wash on your shoulder for 5 applications: twice a day for two days, and then again on the morning of the surgery. This will help reduce your risk of infection 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.
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 to Brisbane, 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 around 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 I did 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
Following os aromiale surgery, recovery involves immobilising the shoulder for six weeks with full time wearing of a sling. During this recovery period, only gentle, limited movements are allowed to help prevent stiffness in the glenohumeral joint, and minimise swelling and pain. Time off work will be required.
Once the sling is no longer required, physiotherapy can be commenced, with a full recovery usually taking between 6 and 12 months.
Rehabilitation
Rehabilitation after os acromiale surgery focuses on improving pain and inflammation, as well as restoring range of motion.
Physiotherapy Guidelines
Day 1 Physiotherapy Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling.
Goals:
- Assist in the reduction of pain and management of inflammation
- Minimise GHJ (glenohumeral joint) stiffness while limiting load through the Os Acromiale ORIF (open reduction internal fixation) with early PROM (passive range of motion) limits of elevation < 90° and GH (glenohumeral) external rotation to 45°
Therapy:
- Patient instructed in precautions – No load, no active elevation, no WB, no push/pull
- Sling don/doff and ensure correct fit, demonstrate activities of daily living (showering, dressing etc)
- Exercise program:
- Gentle cervical spine AROM (active range of motion)
- Elbow, wrist & hand AROM (active range of motion)
- Gentle scapular neutral exercises / general posture advise (*no large scapula rolls*)
- Shoulder: passive pendulum <90°, active / passive shoulder external rotation at neutral 30°- 45°
- Assist in the management of pain by: positioning, appropriate sling fitting, cryotherapy initially (x20 min every 2-3 hours for first 3 days post-operatively), then heat may be useful
Follow up:
- See local physiotherapist week 1-2 with good understanding of post op rehab guidelines and precautions, no change in exercises unless advised by Dr Cutbush.
Results After Surgery
Os acromiale surgery is typically successful in improving pain and shoulder function, including range of motion and strength. Both surgery techniques, either fixation or excision, can be successful, however individual factors will influence outcomes. Excision technique surgeries can affect the function of the deltoid, while a small rate of patients who have undergone the fixation procedure may require a revision surgery.