What is a Sub Acromial Decompression (referred to as ASD or SAD)?
The acromion and the end of the clavicle form a bony arch over the top of the humerus. The space under the acromion is called the subacromial space. The structures within the space include the bursa (a lubricating structure) and the tendons of the rotator cuff muscles. Subacromial impingement occurs when bony changes occur either on the under surface of the acromion or the acromioclavicular joint. There is also inflammation in the bursa, which often becomes thickened. There may be some involvement of the rotator cuff tendons.
The operation aims to smooth out the bone, effectively making the space larger and so decreasing pressure on the tendons. The surgeon does this via keyhole surgery and shaves away part of the acromion. During your operation your surgeon will use a tiny camera to look inside your shoulder for other areas of damage. It may be necessary to do an additional procedure at the same time. This might include a rotator cuff repair,or acromio-clavicular joint excision.
What are the risks of having a SAD?
All operations involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time.
The risks are complications relating to the anaesthetic, infection, stiffness and or pain around the shoulder, damage to nerves or blood vessels around the shoulder, need to re-do the surgery.
What can I do to aid the recovery process after my surgery?
Your shoulder is likely to be uncomfortable in the first few days post-surgery. This is normal but can be helped by using ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).
Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist. You should also have a pillow between your knees.
Your sling is for comfort only and you can start weaning yourself of it within the first 2-4 days. You may find it useful to continue to wear the sling at night for a little longer if the shoulder feels uncomfortable. It is generally recommended to wear the sling if you are going out to protect your arm.
Posture can make a significant difference to your pain post surgery. Avoid hitching your shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting with round shoulders.
In the first few days after surgery you will find it helps to support your arm on pillows with your elbow in front of your shoulder and slightly out to the side when you are sitting down (see picture above right).
When will I be fit enough to return to work?
You can self-certify for the first seven days of sickness. Before you are discharged, a medical certificate (sick note) may be issued by your consultant to cover the expected time off you will need. The time that you can return to work will depend on the nature of your work. If you are in a relatively sedentary job you may be able to return as early as 1-2 weeks after surgery. If your job involves heavy lifting or sustained overhead positions it may take up to 6-8 weeks before you can return. Your consultant and physiotherapist will discuss this with you and advise you accordingly.
How long will it be before I can start to resume my normal activities?
You should avoid sustained repetitive overhead activities for up to 12 weeks. You can usually start swimming when your sutures are removed- breast-stroke is advisable initially. Patients generally return to activities such as golf at about 6 weeks. For specific guidance regarding sport or DIY please speak to your physiotherapist.
If you feel comfortable and have good range of movement you can begin driving 1-2 weeks after your operation. It is advisable to check this with your consultant or physiotherapist if you are unsure. It is important to advise your insurance company that you have had shoulder surgery.
Will I need any follow up appointments?
You will be seen in outpatients clinic approximately 1 to 2 weeks after your surgery. This appointment will be made and given to you before you are discharged from hospital.
If you are continuing with your physiotherapy at Spire Liverpool Hospital an outpatient physiotherapy appointment will normally be arranged within the following week. The amount of physiotherapy you require will depend on your individual progress.