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.
Local anaesthetic is also used as part of the pain-relieving technique either by direct injection into the site of the surgery or by numbing the nerves to the whole arm using a technique called a regional block. This is similar to the idea of an epidural anaesthetic frequently used in childbirth and can have benefits in not only providing excellent postoperative pain relief but also in reducing postoperative sickness and nausea.
The surgery is carried out through small incisions around your shoulder using arthroscopic instruments. The aim of the operation is to remove bone at the front of your shoulder (the acromion) which is pressing on the inflamed and damaged tendons.
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 with single stitches that are removed after a week and covered with waterproof dressings.
The operation generally requires a one night stay in hospital and your arm is placed into a special shoulder sling which is primarily for comfort and support. 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 more than two weeks. 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.
In addition to regular treatment with the physiotherapist, follow up should be carried out by your surgeon. This is to monitor and guide progress and look out for complications, which are fortunately rare.