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Arthroscopic subacromial decompression is a keyhole operation used to treat shoulder pain. It is most commonly used as a treatment for shoulder impingement (sometimes also known as shoulder impingement syndrome) or for damage to your rotator cuff. Both these things can cause pain in your shoulder when you raise your arm to the front or side.
Many people who experience shoulder pain will find their symptoms resolve over time with non-surgical treatments or management methods such as rest, pain relief medication, physiotherapy or joint injections.
However, in a minority of cases, these may not relieve symptoms as expected, and arthroscopic subacromial decompression surgery will be needed to relieve pain and treat its cause. . Most people notice a significant reduction in their pain levels and an improvement in their shoulder mobility and range once they have recovered from the surgery.
This page should tell you everything you need to know about having shoulder decompression surgery with Circle Health Group. If you want to speak to a specialist shoulder surgeon, give us a call or book an initial consultation online.
The cost of your private shoulder decompression surgery will depend on various factors, including which hospital you choose and how much damage there is to your shoulder. For a personalised quote, give us a call today.
If you are paying for your own treatment, we will give you a fixed-price treatment package, which includes your surgery as well as any follow-up appointments, and covers your physiotherapy and recovery too. Your initial consultation, and any diagnostic tests you have at this time, will be charged separately. All costs will be confirmed in writing before you have your treatment.
If you are paying for yourself, you can take advantage of our flexible payment options, which allow you to spread the cost of treatment over a period of up to five years.
If you have private health insurance, great! We work with all major providers.
Shoulder pain can affect every aspect of daily life. If you are struggling with any type of shoulder pain, it's important to get an expert assessment as soon as possible so that you know whether treatment will be needed.
At Circle Health Group, we can provide you with fast access to assessment and treatment. With the UK's largest network of private hospitals, it is simple to arrange a private consultation with an experienced shoulder specialist at your local Circle Health Group hospital.
If treatment is needed - whether physiotherapy, pain relief medication, joint injection or arthroscopic subacromial decompression - we can arrange this for you simply and quickly.
To meet with a consultant for assessment of your shoulder problem and to discuss suitable treatment options with them, book a private consultation online or by phoning our friendly bookings team.
We look forward to helping you get out of pain and back to better movement and function in your shoulder.
How your shoulder works
The shoulder is a complex joint, with many moving parts, joint surfaces, ligaments, tendons and muscles all working together to provide a wide range of movement in the arm. If any part of the joint is damaged, it can have a significant impact on many daily activities.
Your shoulder is a ball and socket joint, formed between the humerus and scapula (shoulder blade). The head of the humerus (the 'ball') rests inside a shallow cup-like structure of the scapula called the glenoid (the 'socket').
A layer of tendons surrounds and stabilises the shoulder. This layer is known as the rotator cuff. The rotator cuff muscles attach to the shoulder blade and then become tendons before they attach to the edge of the 'ball'
Every time you lift your arm up to the front or the side, the rotator cuff tendon passes through a narrow space at the top of the shoulder known as the subacromial space.
The upper part of the subacromial space is formed by part of the shoulder blade known as the acromion. Small bony growths (bone spurs) can sometimes form in the subacromial space on the front edge of the acromion. These may rub on the underlying rotator cuff tendon as it moves.
Alternatively, injury to or overuse of the tendon may cause it to swell, leading to problems as it tries to move through the small subacromial space.
Similarly, the subacromial bursa situated between the tendon and acromion may also become inflamed due to overuse or injury.
Before any type of surgery is considered for a shoulder problem such as impingement or damage to the rotator cuff, conservative (non-surgical) treatments are nearly always used, as these can be very effective for many people.
Many shoulder problems will settle naturally over time with rest. Pain relief medication and anti-inflammatories such as ibuprofen may also help. Always be sure to check with a pharmacist or doctor before taking any medication for the first time.
Physiotherapy is very helpful too - and our physiotherapists can tailor a programme for you.
An injection of local anaesthetic and steroid into the subacromial space will often relieve the pain in resistant cases, although this may need to be repeated.
Considerations for shoulder decompression surgery
If these conservative treatments - exercise therapy under steroid injection over a period of a minimum of three months - are not successful, subacromial decompression surgery may be considered.
To be considered for subacromial decompression surgery, you must have had:
- Pain in the shoulder for at least six months
- Pain that responded to steroid injections into the subacromial space for a short period of time (this confirms where the pain is coming from)
- A course of physical therapy for a minimum of three months, as many people will find that physiotherapy is all they need to relieve their pain
We asked Mr Ben Gooding, a Consultant Orthopaedic Surgeon at The Park Hospital, to explain arthroscopic subacromial decompression in a bit more detail:
"The principle of arthroscopic subacromial decompression is to open the space around the rotator cuff tendons so they aren't trapped and so that their blood supply can improve and promote healing.
"It is a combination of releasing tight soft tissues, removing the second subacromial bursa and shaving away any bone spur on the underside of the acromion that might be trapping the tendons.
"Importantly, it also allows us to look at the other structures of the shoulder, such as the rotator cuff, to see if there is any additional damage within the joint."
When you first meet with your consultant at your local Circle Health Group hospital, they will talk with you about your shoulder pain. They will want to know:
- What symptoms you have
- When they started
- Whether you have tried any treatments up to this point
They will carry out a clinical examination of your shoulder and this will often be all that is needed to confirm a diagnosis.
Occasionally, shoulder X-rays and further diagnostic scans may be necessary to exclude arthritis or tendon tears. These are easily arranged for you at the hospital if they are needed.
If physical therapy and joint injections have been tried but have not been as successful as anticipated, subacromial decompression surgery may be advised.
Your consultant will talk you through the procedure, explaining what happens, how the surgery is carried out and what to expect from your recovery. If you have any questions or concerns, they will be very happy to discuss these with you.
In simple terms, arthroscopic subacromial decompression creates more room in the subacromial space for the tendon to run freely underneath.
Arthroscopy is a type of keyhole surgery. Two or three tiny incisions are made into your shoulder and a thin metal tube with a camera and bright light at one end (known as an arthroscope) is inserted into the shoulder to give your doctor a clear view of the shoulder joint.
Small surgical instruments are then inserted into the joint, and the arthroscope transmits to a screen so that your surgeon can see what they are doing. Typically, the coracoacromial ligament is released, and a powered shaver is used to remove 4-5mm of bone. The detached ligament will re-attach as part of the healing process.
Sometimes the operation will be done using a nerve block, where you will be awake but not able to feel anything in your shoulder. Other times, a general anaesthetic will be used.
How long does shoulder decompression surgery take?
The operation is normally a day case, meaning you will be able to go home the same day.
In Mr Gooding's experience, the whole process - from going into the operation through to being in theatre recovery and being taken back to the ward after the surgery - takes around 90 minutes. However, exact timings vary for each person.
If during the surgery additional damage is found, like a tear in the rotator cuff, this can normally be treated at the same time. Not everybody will need this - Mr Gooding estimates that roughly one in every 10 patients he sees for arthroscopic subacromial decompression is found to have additional damage that needs repair.
Physiotherapy will start the day after your surgery, but it will take around six weeks before you feel substantially recovered in terms of pain, strength and range of movement in your shoulder.
While your shoulder should feel much better within a couple of weeks of surgery, you will probably still get some pain or discomfort in the shoulder for a while. This is a normal part of the healing process. The pain will improve over time, but your doctor may advise you to have painkillers for a certain period.
It can take up to a year to rehabilitate the shoulder fully and to strengthen the tendons that were irritated. Your recovery will be affected by a number of factors, including:
- Your general health
- The extent of any damage to the tendon pre-surgery
- How consistently you do any prescribed rehabilitation exercises
As the surgery involves only very small cuts in your shoulder, the wounds will usually heal quickly. You will have a waterproof dressing covering the shoulder, so you will be able to shower once you are home.
Your consultant will normally talk with you - either by telephone or at the clinic - at the six-week mark to make sure that everything is healing as expected.
A very small number of people may need further treatments, such as a steroid injection, to reduce inflammation after the surgery. Although this is not a common problem, the post-surgical follow-up at six weeks helps ensure it is caught and resolved.
To help restore function and strength to your shoulder, your physiotherapist will show you certain exercise and/or stretches to do daily. These help to prevent stiffness from developing in your shoulder while you heal.
As your shoulder recovers, you will find you can move your arm more freely and with increased range. You should always be guided by what your body can manage, and any pain will ease with time and sensible exercise.
You may find that if you lift your arm to shoulder height or above (reaching for something on the top shelf of a cupboard for example), it is still quite painful in the early stages of your recovery, as this is the position that places maximum stress on the area that has been operated on.
Most people will be able to move their arm below shoulder height with minimal pain after two to four weeks, and above shoulder height with minimal pain six to eight weeks after their surgery.
Most of your recovery and rehabilitation will be overseen by the physiotherapy team, but your consultant is available for queries or further treatment advice. If you have any questions or concerns at any stage of your recovery, it is easy to get in touch with us for help and advice.
As a type of keyhole surgery, subacromial decompression is a safe procedure. However, any surgery has potential risks as well as the expected benefits. These will be explained to you fully before you decide whether to have surgery or not. You will always have the information you need to make an informed choice.
Possible risks of arthroscopic subacromial decompression include:
Infection in the shoulder joint
This is a rare but serious complication that will need prompt treatment with antibiotics.
Bleeding
You may experience a small amount of bleeding under the skin, which may cause a small lump to develop at the wound site (haematoma). Temporary bruising is common.
Nerve damage
Damage to the nerves around the shoulder is very rare, but may cause some weakness, numbness or pain in the arm and/or hand. If this does happen, it will normally settle on its own, but it may be permanent.
Stiffness
Stiffness in your shoulder may develop if you do not do the exercises and stretches you are given by your physiotherapist. The surgery is just one aspect of your total treatment, and physiotherapy throughout your recovery is vital to getting the maximum benefits.
If your stiffness becomes very troublesome, a steroid injection and occasionally manipulation under anaesthetic (MUA) may be required.
As the UK's largest network of private hospitals, we can provide you with fast access to a leading shoulder specialist, wherever you live.
Your consultant will carry out a thorough assessment of your shoulder to get a diagnosis and arrange tailored treatment for you. If arthroscopic subacromial decompression is needed, this can be arranged for you without having to spend weeks or months on a waiting list.
Your local Circle Health Group hospital can provide you with:
Fast access to an experienced shoulder surgeon
Circle Health Group hospitals provide private consultations throughout the week, with many running Saturday and evening clinics.
A faster diagnosis
You will only ever see a consultant at a private consultation. Because you will never be seen by a junior doctor, your assessment, diagnosis and treatment are all much more streamlined. This means you will be able to begin any treatment at a much earlier date, relieving your pain and improving your shoulder health sooner.
Flexible appointments
Private consultations can be booked on a day of your choosing and at a time that is most convenient to you. You can also choose the consultant you see if you would like.
It is very easy to book a private consultation at your local Circle Health Group hospital, and you can do this online or by phoning our bookings team.
Rapid access to imaging
While many shoulder conditions can be diagnosed from a clinical history and physical examination of the shoulder, diagnostic imaging is sometimes needed to help confirm a diagnosis or to rule out other causes.
Every Circle Health Group hospital offers fast access to imaging like X-ray, MRI and ultrasound scans. Onsite radiologists provide fast reporting so that results are back with your consultant as soon as possible.
If you are struggling with pain, stiffness or any other problem in your shoulder, it's time to see a shoulder specialist for assessment and treatment advice.
Whether the problem is new or one you have been struggling with for a while, the team of shoulder specialists at your local Circle Health Group hospital would be delighted to help you get the support you need as soon as possible.
If treatment is needed, we are here to help you. Contact us today to book your private shoulder consultation - we look forward to welcoming you.
