Overview
Reviewed by Dr. Peter Simonian
The tip of the shoulder blade (scapula) that forms the roof of the shoulder joint is known as the acromion. Where this bone meets the collarbone (clavicle) is known as the acromioclavicular (or AC) joint. Normally, the tendons of the shoulder and the fluid-filled sac known as the bursa have plenty of room underneath the AC joint. However, overuse of the shoulder may lead to bursitis or tendonitis, collectively known as impingement. Impingement causes the tissues underneath the AC joint to be pinched against the bone, causing irritation and pain. Additionally, arthritis can develop in the shoulder as a result of overuse (osteoarthritis) or autoimmune attack (rheumatoid arthritis). Physical therapy, medication, or cortisone injections are most often prescribed for shoulder pain; however, if these methods fail to work, arthroscopic surgery may be necessary.
The surface of the acromion that faces the inside of the shoulder joint can be misshapen, rough, or large, and may develop bone spurs as well. By jutting further into the space where the bursa and tendons lie, a misshapen acromion presses against the tissues within the shoulder joint, causing irritation and pain in the arthritic or impinged shoulder. A surgeon can reshape the acromion while performing arthroscopy to increase the amount of room inside the joint. The procedure often is accompanied by a distal clavicle resection, removal of the coracoid ligament, debridement, or as part of a subacromial decompression.
Detailed Description
Specialist
Orthopedic surgeon
Procedure
Before the procedure:
The patient's medical history and any possible allergies to medication are determined. The surgeon may order X-Rays, an MRI, CT Scan or EMG to look into the joint before the procedure. The patient is dressed in a hospital gown and anesthetized either locally or generally.
During the procedure:
A number of half-inch incisions will be made to allow the arthroscope to enter the shoulder joint. A sterile saline solution will be pumped into the joint both to cleanse it and to expand it for better visualization. The surgical staff may also pump air into the joint to create more room to see inside the joint. While watching a monitor that shows a magnified image of the inside of the shoulder, the surgeon guides the arthroscope to perform a number of procedures within the joint.
After removing any dead or damaged tissue around the AC joint and bursa (see debridement), the surgeon will perform an impingement test on the joint to determine the amount that bone spurs interfere with the fluidity of the joint. The surgeon will then use a burr or small, motorized drill, to remove the rough bone spurs from the acromion. The patient may be discharged following the procedure, or may remain in the hospital for one to two days.
Recovery
Recovery from the procedure most likely involves wearing a sling, which is removed for longer periods of time as healing progresses. The patient may be instructed to perform Codman exercises. In the first Codman exercise, the patient bends at the waist, allowing the arm to hang downward, and makes clockwise and counterclockwise circles with the wrist. In the second, the patient remains bent at the waist, supporting his or her weight with the other hand, and pulls the arm across the body so as to increase the range of motion. The motions are usually preceded or followed by icing the joint. Codman exercises should only be done under the supervision of a physical therapist. Gradually, the patient can expect to work up to shoulder shrugs and weight-bearing exercises, as well as more exercises to increase range of motion. As always, consult your doctor before undertaking any rehabilitation exercises.
Complications/Risks
- Blood clots (very rare)
- Surgical wound infection
- Reaction to anesthesia
- Risk of developing arthritis
- Weakening of muscles
- Stiffness
- Neurovascular injury
Medications
Prescription and non-prescription painkillers, shoulder sling for support.
Follow up with your doctor if…
You experience increasing pain, prolonged swelling, decreased sensitivity or decreasing joint motion after the procedure. Also, if you experience any symptoms suggestive of infection such as general malaise (tiredness) or fever, notify your doctor.
Last updated: 06-Jun-03
