Shoulder Acromioplasty

Surgical treatment in the context of subacromial impingement consists of performing an acromioplasty.

Surgical indications:

• In case of prolonged or recurrent subacromial impingement
• In case of persistent pain and functional impairment
• In case of aggressive character of the acromial vault (acromion, coraco-acromial ligament, aggressive acromioclavicular joint…)

Related pathology: Subacromial impingement

Acromioplasty corresponds to decompression of the subacromial space by filing and thinning of the acromial bone at its deep part.

This is a surgical intervention performed under arthroscopy allowing to file and sand the deep part of the acromion.

Shoulder arthroscopy corresponds to the introduction of a camera into the joint and subacromial space to explore and treat different lesions.

The interest of arthroscopy compared to open interventions is the absence of muscle lesion due to the absence of extensive surgical approach but also the much lower risk of infection or hemorrhage and the quasi absence of post-operative scar at distance.

The goal of the intervention is to clean the subacromial space and decompress it. Under arthroscopy, different surgical instruments allow to file and sand the deep face of the acromion but also to release the coraco-acromial ligament often conflictual. It will also be possible to perform partial joint resections notably of the outer quarter of the clavicle in case of acromioclavicular arthropathy.

This decompression is done with 2 or 3 incisions of approximately 1 cm allowing to pass surgical instruments and the camera.

Note: in case of associated lesion of rotator cuff tendons or other ligament lesion, it will be possible in the same operative time to perform repair of these different lesions under arthroscopy.

• Immobilization: by orthopedic vest for a duration of 2 to 4 weeks according to pain intensity
• Self-physiotherapy: from the first days for muscle relaxation work and gentle mobilization
• Surgical dressing: on day 5, 10, 15 and suture removal on day 15
• Analgesics: according to pain
• Control appointment: with surgeon at one month

Physiotherapy has a fundamental role in the background treatment of subacromial impingement after surgical intervention.

The main goal will be work of shoulder recentering but also decompression as well as shoulder lowering.

The duration of postoperative physiotherapy is usually 2 to 3 months.

The intervention taking place under arthroscopy with instillation of lavage fluid throughout the intervention, complications are extremely rare notably concerning risks of hemorrhage or infection.

Main risks after arthroscopic acromioplasty:

• Infection
• Hemorrhage or hematoma (during or after intervention)
• Nerve lesion (brachial plexus, axillary nerve…)
• Painful recurrence, tendinitis, bursitis (often after physiotherapy not performed post-operatively)
• Complex regional pain syndrome of the upper limb

All precautions are put in place before, during and after the surgical intervention to minimize these complication risks as much as possible.

• Hospitalization: Outpatient (ambulatory)
• Anesthesia: General ± regional
• Immobilization: Sling for comfort a few days
• Physiotherapy: Progressive over 6–8 weeks