What is the Surgery for Shoulder Impingement Syndrome

Shoulder impingement syndrome is a condition that causes pain when connective tissues (tendons) surrounding the shoulder joint become pinched by bony structures (bone spurs). These tendons are part of the group of muscles and tissues that help to stabilize the shoulder (rotator cuff). The surgery to relieve impingement syndrome (subacromial decompression) removes the bone spurs, which allows the tendons to move more freely during arm movement.

During this procedure, your surgeon may:

• Reshape a bone in the shoulder (acromion).
• Cut the coracoacromial ligament. This ligament connects the acromion to a bone near the shoulder joint (coracoid process). Cutting the ligament gives the shoulder joint more space to move without pain.
• Remove a fluid-filled sac under the acromion (subacromial bursa). The subacromial bursa can swell (subacromial bursitis) and cause or worsen shoulder impingement syndrome.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have, such as arthritis.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures and organs, such as nerves, shoulder muscles, or the shoulder blade (scapula).
• Shoulder pain that does not go away or keeps coming back (recurs).
• Permanent shoulder stiffness, weakness, or limited range of motion.
• Removal of too much or too little of the acromion.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Ask your health care provider how your surgical site will be marked or identified.
• You may have imaging tests of your shoulder, such as:
  • X-rays.
  • MRI.
  • Ultrasound.
• You may have a blood or urine sample taken.
• You may be given antibiotic medicine to help prevent infection.
• Plan to have someone take you home after the procedure.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic). You may also be given a medicine to help you relax (sedative).
• Several small incisions or one larger incision will be made in your shoulder.
• Depending on the cause of your condition, any of the following may be done:
  • The coracoacromial ligament may be cut using a surgical knife (scalpel).
  • The subacromial bursa may be removed using surgical scissors.
  • The acromion may be reshaped. Any bone spurs may be removed with a small power drill (burr), electric shaver, chisel (osteotome), or file (rasp).
• Your incision(s) will be closed with stitches (sutures), skin glue, or adhesive tape. Bandages (dressings) may be placed over your incision(s).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• You may continue to receive fluids and medicines through an IV tube.
• You will have some pain in your shoulder and surrounding area. Medicines will be available to help you.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You may have to wear compression stockings. These stockings help prevent blood clots and reduce swelling in your legs.
• You may be asked to gently move your arm and shoulder to test your range of motion.
• Do not drive for 24 hours if you received a sedative.

Surgery for Shoulder Impingement Syndrome, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After your procedure, it is common to have pain and stiffness in your shoulder area. This may include your arm, chest, and back.

Follow these instructions at home:

If you have a sling:

• Wear the sling as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the sling if your fingers tingle, become numb, or turn cold and blue.
• Do not let your sling get wet if it is not waterproof.
• Keep the sling clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If you have a sling that is not waterproof, cover it with a watertight covering when you take a bath or a shower.
• Keep your bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to be in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you received a sedative.
• Ask your health care provider when it is safe to drive if you have a sling on your arm.

Managing pain, stiffness, and swelling

• Move your fingers often to avoid stiffness and to lessen swelling.
• Keep your arm and shoulder in the position recommended by your health care provider.
• If directed, put ice on your shoulder.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider tells you that it is safe.
• Do exercises and stretches as told by your health care provider.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have pain that gets worse or does not get better with medicine.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have muscle aches.
• You are dizzy.

Get help right away if:

• You have severe pain in your shoulder, arm, or hand.
• Your hand or arm becomes numb.
• Your hand or arm feels unusually cold.
• Your fingernails turn a dark color, such as blue or gray.