Open Acromioplasty

Overview
Reviewed by Dr. Jon Warner
(Also known as Bankart procedure)

The tip of the shoulder blade (scapula) that forms the roof of the shoulder joint is known as the acromion. The acromioclavicular (or AC) joint is where this bone meets the collarbone. 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 impingement. Impingement causes the tissues underneath the AC joint to be pinched against the bone, causing irritation and pain. In addition, 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, open 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 open-shoulder surgery 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, a combination of some of the procedures mentioned earlier designed to maximize space between the acromion and the rotator cuff tendons.

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:

The surgeon makes a long incision to gain access to the joint, often cutting through the deltoid muscle to operate on the internal structures of the shoulder. After removing any damaged tissue around the AC joint and bursa (see debridement), the surgeon will perform an impingement test on the joint to determine the degree to which the acromion rubs against the tissues inside the shoulder. The surgeon will then use a burr, or small, motorized drill, to remove the last one-third of the acromion. The deltoid is stitched together and anchored to the scapula, and the surgical wound is sutured. The patient may be discharged following the procedure, or may remain in the hospital for one to two days.

Recovery

The patient may be connected to a Continuous Passive Motion machine, which keeps the shoulder moving to prevent a stiff or frozen shoulder. Recovery usually 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.
Complications/Risks

• Blood clots (very rare)
  
• Surgical wound infection
  
• Slow healing of deltoid
  
• Reaction to anesthesia
  
• Risk of developing arthritis
  
• Weakening of muscles
  
• Stiffness
  
• Neurovascular injury