Shoulder arthroscopic decompression is to take pressure off the inflamed shoulder tendons and to provide a pain free mobile and strong shoulder. The operation is suitable for people whose symptoms have not responded to non-operative methods such as injections or physiotherapy. They have usually undergone assessment of the tendons in the form of an ultrasound scan or MRI scan.
Overall, this sort of surgery should have a success rate of eight and a half to nine out of ten with substantial reduction in pain and a return to normal activity.
The surgery is carried out through small incisions around your shoulder using arthroscopic (keyhole) instruments.
The first step is to use the telescope to carefully assess the whole of the inside of your shoulder joint and tendons. This allows the identification of other problems that might be important, such as arthritis and also allows other minor problems to be dealt with.
The main part of the operation involves removing the inflamed soft tissues (bursa and ligaments) and the bone (anterior acromion) pressing on the top of the shoulder tendons actually outside the main shoulder joint. Sometimes the joint between the collarbone and the acromion (the acromio-clavicular joint) also needs to be removed as part of the procedure.
Once the operation is complete, the small incisions are closed and there may be stitches to be removed after a week and covered with waterproof dressings.
Shoulder and elbow surgery can result in considerable pain and discomfort after the operation. Traditional painkillers are not always effective and have side effects. We usually offer you a local anaesthetic “block” to reduce the pain and discomfort following the procedure and also allow early more comfortable physiotherapy (if required). This consists of an injection at the side of your neck onto the nerves that supply your shoulder. The injection itself is fairly painless.
The procedure is carried out before the start of your operation. You will have a small plastic tube placed in your arm (drip). Then you may have some sedation to make you feel relaxed. A small numbing injection in the skin is placed prior to the block needle (which is smaller than a blood-taking needle). Your arm will then start to feel very heavy and numb (a similar sensation to when you have been lying on it). This spreads down the outside of the arm (and spares the inside).
Surgery is then carried out under sedation (you are comfortable, relaxed and either awake or sleeping if you prefer) or occasionally under general anaesthesia (you are unconscious and unaware). If you are awake, you are welcome to watch the procedure on a TV screen, and we will explain to you what is happening. If you require any extra pain relief during the procedure, we can easily give you this through your drip. The block will reduce the overall amount of painkilling drugs that you will require during and after the operation.
After your operation
The numbness will usually last for between 8 and 24 hours (depending on anaesthetic mixture used). We will leave your arm in a sling; please protect your arm whilst it is numb.
You will initially experience some ‘pins and needles’ as the block wears off and then some pain. Please prepare for this by taking the painkillers that we provide. Start these before the block wears off and expect to need them regularly for around 48hrs.
Occasionally we may recommend that at the time of the block we also place a small tube (catheter) that is fixed in place and through which we can give you further local anaesthetic to prolong your numbness for a few days. We would recommend this in situations where your pain after the operation is likely to be severe.
Complications of Anaesthesia
Anaesthesia is fairly safe for most people. If your health is not good the risks may be increased. Commoner complications include nausea and sore throat.
Local anaesthetic nerve blocks are generally considered to be safe. There is an approximately 5% (1 in 20) chance that they will fail or not work as well as expected. They tend to cause a small pupil and droopy eyelid temporarily and you may notice a hoarse voice or slight breathlessness.
Rare complications include reactions to the local anaesthetic solutions and nerve injury (the risk of temporary nerve symptoms e.g. tingling, numbness or weakness for a limited period is around 1 in 100 blocks and the overall risk of permanent injury approximately 1 in 5,000- 10,000 injections).
Paracetamol and an anti-inflammatory drug (if suitable for you – usually ibuprofen or diclofenac) are often used in combination. Take these regularly for the first few days.
Your anaesthetist will talk to you about strong painkillers, usually codeine, tramadol, oxycodone or morphine. Take these if your pain is poorly controlled (instructions will be on the packet). Some patients experience light-headedness when taking stronger painkillers; so be careful especially at first (rest up after taking them, don’t carry hot drinks or anything sharp) and take them only to counteract severe discomfort. Nausea and constipation can also occur, so drink plenty of water and increase the fibre in your diet; occasionally laxatives may be required (available from chemists).
If you are discharged on the same day as your operation, there should be someone keeping an eye on you during the first 24 hour period. If the painkillers make you excessively drowsy, then your carer needs to rouse you and ensure you not too sensitive to them.
Emergency contact numbers will be available on your discharge information if you or your carer wishes to talk to a trained member of staff.
The operation is usually a day case and your arm is placed into a special shoulder sling which is primarily for comfort and support until any anaesthetic wears off. Exercises and physiotherapy start on the day of surgery and patients are your physiotherapist will teach you all you need to know for the first couple of weeks after discharge from hospital.
As a general guideline, the sling is rarely necessary for a period of 24 hours. During this time, you are encouraged to start using your hand but it is unlikely that you will be able to do much actively with the arm when the shoulder is moved away from the body.
Most people can start driving a car between two and three weeks and have regained good ordinary use of the shoulder by six weeks. Inflammation and discomfort generally settle over a period of two to three months and physiotherapy and exercises continue for this period of time.
Activities such as running and swimming start to be resumed at around four weeks but activities that are more demanding on the shoulder such as racquet sports, golf and gardening are resumed at two to three months.