Rotator Cuff Impingement - Acromioplasty site (-spur- has been removed)Impingement syndrome is a term that is used to describe a diagnosis. The diagnosis is one related to pain coming from the rotator cuff tendon. If you’ve read the general information about [rotator cuff tears], you’ll note that there is a lot of similarities in discussion about partial rotator cuff tear and “impingement syndrome”.

Impingement syndrome is a term often used by a shoulder specialist interchangeably with the term “partial rotator cuff tear” or “rotator cuff tendonitis”. A common theory of shoulder pain is that “impingement” is responsible for making the rotator cuff tendon hurt more when it is inflamed. It is also believe that “impingement” can result in partial or complete tearing of the rotator cuff tendon over a long period of time.

It is often taught that impingement occurs on the rotator cuff tendon because of an unfavorable shape of the undersurface of the acromion. The acromion is a portion of the shoulder blade, the scapula. There are many references that describe the shape of the acromion as one of three types: Type I, Type II, or Type III.

I have never been able to make much of a distinction between any two adjacent types. I’m not alone. There is little reproducibility among examiners in their ability to consistently categorize an acromion as one of these three types.

The significance of the different types is that Type I is generally considered to be “normal”, and a type III is generally considered to be “abnormal”. It is thought that impingement problems are more common in patients that have a Type III acromion. The classification of acromion morphology (shape) is not of much practical value to me, because I find that patients with a Type I acromion can have impingement syndrome. Presence of a Type III acromion does not necessarily mean that person has impingement syndrome.

You may have heard the term “spur”, for example, in a shoulder patient who had surgery to “remove the spur”. That reference generally refers to a bony prominence on the undersurface of the acromion.

Treatment

Impingement syndrome is treated exactly like rotator cuff pain or a partial rotator cuff tear.

Rotator Cuff Debridement with Arthroscopic Acromioplasty

Rotator Cuff Debridement with Arthroscopic Acromioplasty FAQs

What surgery are you suggesting?

I am suggesting that we operate on your shoulder to remove a small prominence of bone on the undersurface of the acromion and to trim the frayed portion of your rotator cuff tendon. The acromion is part of the shoulder blade.

 

Pre-op Instructions     Post-op Instructions

Is it done in an operating room?

Yes.

Will I be anesthetized?

This is usually done under a general anesthetic. The surgery can also be done with just the shoulder anesthetized. That method involves numbing nerves to the shoulder. It is called an interscalene block. It is common to be sedated if the surgery is done with an interscalene block. The sedation is such that most patients will take a nap during the procedure. You and your anesthesia professional will decide which anesthetic is best for you.

Do I have to stay in the hospital?

No. This is an outpatient procedure in most cases.

What are the alternatives to surgery?

This surgery is done to improve function and decrease pain. If a patient finds that their pain and function are acceptable, it is reasonable to decline surgery. Some patients with significant impingement progress to worsening shoulder pain as the months go by, while others will improve. The decision on when to operate is up to the patient based on pain and function.

What is arthroscopic acromioplasty and rotator cuff debridement?

It is a way of removing a small prominence of bone without making a large incision in the shoulder. Typically, one wound is made on the posterior aspect of the shoulder, another on the lateral aspect of the shoulder, and another on the front. Each of these is about ⅜ inch long. Through these incisions, one can enter the shoulder joint and perform the surgery, which consists of removing the prominence of bone with a small burr – similar to a dentist’s drill, but larger.

About Your Doctor

How many of these have you done?

I do not have an exact total. I have been performing surgery since 1981. I do operations on the shoulder at a rate in excess of 250 per year. I am a Board Certified Orthopaedic Surgeon. I have been in practice at Piedmont Orthopaedics since 1986. I subspecialize in my practice, and most of what I take care of relates to problems of the shoulder.

Risks

What are some of the things that could go wrong?

The anesthesia carries risks with it. The person who evaluates you for your anesthetic will discuss those risks with you. In general, complications from anesthesia are very, very rare, but they do exist.

How often does an infection occur?

Approximately 1% of shoulder surgeries become infected soon after surgery.

What happens if there is an infection?

Infection will sometimes require that another operation be done on the shoulder. During that surgery the infection is washed out and intravenous antibiotics are often begun. Intravenous antibiotics may be necessary for 6 weeks, and long-term oral antibiotics may be necessary as well.

Will my shoulder get stiff?

It takes about 4 weeks to 6 weeks to gain maximal flexibility and strength of the shoulder after this operation. Some patients will take as long as a year to gain that maximum flexibility. Almost all patients recovering from this operation feel very tight for the first couple of months after the operation. About one in 20 patients will develop a “frozen shoulder” after this surgery. They generally experience about four weeks of significant stiffness that dramatically slows their progress. It will resolve with exercise and time.

Could I die?

No surgery is absolutely safe. It is possible that one could die from any type of operation. The death rate from this operation is profoundly low. I would estimate that it is less than 1 in 10,000. Other major events such as heart attack or stroke are extremely rare following this type of surgery.

Will I need a blood transfusion?

Almost certainly, no.

Will it relieve my pain satisfactorily?

I find that about 70% of patients with arthroscopic acromioplasty and rotator cuff debridement are extremely happy with the result. Another 20% or so are happy with reservations. As an example of what that means, a patient says their shoulder feels much better and performs better, but they still have some aching. Approximately 10% of patients feel as if the shoulder surgery was not beneficial to them.

Will I have limitations on what I can do after it is healed?

No. It is safe to pursue all activities without restrictions once completely healed.

A Common Sequence of Recovery

What is involved in this type of surgery?

In preparation of surgery, you will be asked to not eat or drink for at least 8 hours prior to surgery. Specific times to stop all food and drink will be given to you by your anesthesia professional. If you are on a drug that causes blood thinning such as Plavix, Coumadin, or Xarelto, be sure to mention that to me. It may be important that those drugs be stopped well in advance of surgery. If you have rheumatoid arthritis or lupus and are on certain drugs for those conditions, they too may need to be stopped prior to surgery.

The anesthesia personnel who evaluate you for surgery will determine what lab work, if any, is needed. On the day of your surgery, you will be asked to arrive well in advance of the surgical time. After surgery is over, you will need to remain at the facility for at least 1 hour. It is okay to eat or drink as soon as you feel like it after surgery. Your pain can be controlled by using the pain medication pills that I will prescribe for you. Pills will not eliminate all of the pain, but they will make it tolerable. Pain may be severe in the first few days. Pain can also be helped by the use of ice on the shoulder, sitting in an upright position as in a recliner and resting the arm in a position of maximal comfort to the side. Within the first 2 weeks of surgery, I usually recommend beginning some exercises to the shoulder. I will either instruct you in how to do these or I will ask a therapist to do so.

What about the overall recovery from this operation? How long does it take to completely recover?

Approximately 6 months is common.

Will I be hurting that long?

No. Generally, within a week or two a person notices a significant diminution in their pain. They continue to gain further improvement steadily after that.

How long will I need prescription pain medication?

This varies widely. There are occasional patients who will use only a day or two of prescription pain medication. Much more commonly, I see patients using narcotic analgesics until about one week following surgery. One of the last discomforts to go away is nighttime pain, and many patients will still use a pain pill to help them sleep for as long as 3 weeks after surgery.

When are the sutures removed?

I use surgical glue. No sutures or staples require removal.

When can I get it wet?

The surgical glue is waterproof, so it is okay to take a bath or a shower from the very first day.

Will I have to wear a sling?

Yes. A sling is provided at the time of surgery and the patient is instructed to use it until comfortable without it. Some patients will give it up in a day, while others will use it for a week or more. If you are resting comfortably in a chair at home, it is fine for the sling to be off.

Is any special wound care required?

The scar will look prettier sooner if you rub vitamin E or cocoa butter into it.

What surgery are you suggesting?

I am suggesting that we operate on your shoulder to remove the end of the clavicle (collar bone.)

Pre-op Instructions     Post-op Instructions

Is it done in an operating room?

Yes.

Will I be anesthetized?

Yes. This surgery is usually done under a general anesthetic. You and a professional anesthetist will decide which anesthesia is best for you.

Do I have to stay in the hospital?

No. This procedure is done on an outpatient basis.

What are the alternatives to surgery?

This surgery is done to improve function and decrease pain. If you find that your pain and function are acceptable, it is reasonable to decline surgery.

Will my shoulder get stiff?

Usually not.

About Your Doctor

How many of these have you done?

I do not have an exact total. I have been performing surgery since 1981. I perform surgeries on the shoulder at a rate in excess of 250 per year. I am a Board Certified Orthopaedic Surgeon. I have been in practice at Piedmont Orthopaedics since 1986. I subspecialize in my practice, and most of what I take care of relates to problems of the shoulder.

Risks

What are some of the things that could go wrong?

The anesthesia carries risks with it. The person who evaluates you for your anesthetic will discuss those risks with you. In general, complications from anesthesia are very, very rare, but they do exist.

How often does an infection occur?

Approximately 1% of shoulder surgeries become infected soon after surgery.

What happens if there is an infection?

Infection will sometimes require that another operation be done on the shoulder. During that surgery the infection is washed out and intravenous antibiotics are often begun. Intravenous antibiotics may be necessary for six weeks.

Could I die?

No surgery is absolutely safe. It is possible that one could die from any type of operation. The death rate from this surgery is profoundly low. I would estimate that it is less than 1 in 10,000. Other major events such as heart attack or stroke are extremely rare following this surgery.

Will I need a blood transfusion?

Almost certainly, no. You will likely lose less than four ounces of blood.

Will it relieve my pain satisfactorily?

I find that about 95% of patients are very happy with the result after they have completely recovered from this type of surgery. Of the remaining 5%, most are improved, but some have reservations such as mild pain.

Will I have limitations on what I can do after it is healed?

No. It is safe to pursue all activities without restriction once completely healed.

A Common Sequence of Recovery

What is involved in this type of surgery?

In preparation of surgery, you will be asked to not eat or drink for at least 8 hours prior to surgery. Specific times to stop all food and drink will be given to you by your anesthesia professional. If you are on a drug that causes blood thinning such as Plavix, Coumadin, or Xarelto, be sure to mention that to me. It may be important that those drugs be stopped well in advance of surgery. If you have rheumatoid arthritis or lupus and are on certain drugs for those conditions, they too may need to be stopped prior to surgery.

The anesthesia personnel who evaluate you for surgery will determine what lab work, if any, is needed. On the day of your surgery, you will be asked to arrive about 2 hours prior to your surgery time.

After surgery is over, you will need to remain at the facility for at least an hour. It is okay to eat or drink as soon as you feel like it. Your pain can be controlled by using the pain medication pills that I will prescribe for you. Pills will not eliminate all of the pain, but they will make it tolerable. Pain may be severe in the first few days. Pain can also be helped by the use of ice on the shoulder, sitting in an upright position as in a recliner and resting the arm in a position of maximal comfort to the side. I will probably recommend that exercises to your shoulder begin about two weeks after the operation.

What about the overall recovery from this operation? How long does it take to completely recover?

Approximately 3 months is common.

Will I be hurting that long?

No. Generally within a week or two a person notices a significant diminution in their pain. They continue to gain further improvement for several weeks after that.

How long will I need prescription pain medication?

Most patients will use it regularly in the first week and periodically until about two weeks following surgery. Often by week three, it is only used at night.

When are the sutures removed?

I use surgical glue, so no sutures will require removal.

When can I get it wet?

I use waterproof surgical glue, so it is okay to take a bath or shower from the very first day.

Is any other special wound care required?

Your scar will look prettier sooner if you rub vitamin E into it.

Will I have to wear a sling?

Yes. A sling is provided at the time of surgery and the patient is instructed to use it for the first few days following surgery. It can be removed in certain environments, as in the safety of your home. It is fine to move your arm as much as you would like immediately after surgery.