Acromioplasty (Subacromial decompression)

I don't think I can put it off any longer. How bad is the recovery? The PA who shoots me with cortisone says its not all that bad, but then he also says there's no lifetime limit on cortisone shots either. Anyone have experience with this?

A decompression should be very straight forward and the recovery is not bad because all they are doing is shaving down the spur on the acromion process. So the pain is sort of like a fracture site but not as bad its different. The patients that I have treated post op say it was a good decision to get it done. It is a rather straight forward procedure really and there recovery time was not long compared to what they put up with. A few months of PT and they were back to regular activity, now this was based on their pre-surgical conditioning and some other factors.

Now the thing you need to get the surgeon to swear on ... well whatever but get him to absolutely swear he will not do any repair of any tendons or anything with the joint capsule. The reason being any repair adds months to your down time and rehab. Biceps tendon repair 6 to 8 weeks in a gunslinger, SLAP lesions about the same and the list goes on, these repairs can take a year to be back to normal. Some are more aggressive others more conservative with how fast rehab goes.

So decompression, not a bad way to go gets the joint nice and cleaned up. Get some good rehab going and you should be good to go. Try to get with a good PT before surgery and work on it as much as you can tolerate pre-op wise, I have always found this makes it easier to resume therapy post-op.

I underwent subacromial decompression 10 or 12 years ago. I have the type 3 acromian which is the most "hooked" one i.e. the type that creates the least space inside the joint capsule. Thus every time I reach over my head there is some impingement. I just gritted my teeth and dealt with the pain for many years and never tried cortisone. It was my first surgery, and I had a lot of trepidation about going under the knife (laprascopic surgery to be more accurate).

Anyhow, the procedure itself was OK. The surgeon went into my shoulder from three spots. Immediate side effects were sore throat from the breathing rig (intubation?) and a serious 2 day hangover from the anesthesia. The antibiotics didn't do my digestion any favors either. There is no option not to take them due to risk of infection. Probiotics are a must to rebuild intestinal flora. I did have a lot of post op pain which is normal and was definitely using the painkillers they gave me. My range of motion in my arm was amazingly limited for quite a while. Getting my arm up to 90 degrees from my torso took months. For some time it was impossible to hard to put on any shirt that didn't button down the front. I think I was in a sling for 2 weeks or so. My entire pectoral and tricep turned black and blue from all the dead cells flushing out of the joint capsule.

The end result for me was this: I definitely lost strength in that shoulder but ended up with a lot less nagging pain. After surgery I really had to back off steeper climbing on overhanging terrain and roofs--which was a bummer. I should have gone straight into PT afterwards but my doc never recommended it; his mistake. Overall it was worth it, but the surgeon definitely downplayed the recovery time. I'll always remember his advice when I came in for post op checkups, "Let the pain be your guide."

I had it done 6 or 7 years ago. It was an arthoscopic procedure performed at Stanford University by Tim Mc Adams. I had no post operative pain, I literally took 1 Vicodin then realized I didn't need them. I was fitted with a sling and cooling pad that used circulating ice chilled water whilst in Surgery which was removed about 4 days later when I returned for a checkup. I kayaked a class IV river a week later, back to full blown class V within the month (Probably shouldn't have done that!). The surgeons advice WAS to go easy for 5-6 weeks until the sharp and rough surfaces created during the procedure had become smooth and lubricated again. Still problem free to this day.

Ian- do you know what type of acromion you had? Like tigerclaw, mine is a 3; an eagles beak. Feels like a big fat nail is stuck into my shoulder.
And thats awesome how you 2 could not have had more different of an experience.

Tigerclaw, sorry you had such a rough experience. I have been a PT for nearly 20 years and have treated a lot of shoulders and in that time I can't recall someone with that kind of bruising after even a capsular or tendon repair. Did you by chance have a tear in the supraspiantus that was not repaired? Often times with a grade 3 spur there will be a partial thickness tear in that tendon. Some surgeons insist on repairing it others will let it go to heal on its own. If the later was the case then that could account for the prolonged healing time and limitations.

Ian's experience is definitely the more usual outcome. And class V within a month - nope not the best idea.

O&B - one of the things to consider is that the damage is done so you can still workout and keep your strength just don't take it to the point of constantly inflaming the joint. The stronger you go into surgery the better you will do post op. And PT is a must for any shoulder surgery. The sooner post op the doc allows the better. The patients that had the best outcomes where the ones that had pre-op therapy and were allowed to start therapy post op sooner, not just for an acromioplasty.

There is a thread on shoulder rehab that has a lot of good information - it's not too far down in the list maybe 2 days ago or so.

Old and Busted wrote:Ian- do you know what type of acromion you had? Like tigerclaw, mine is a 3; an eagles beak. Feels like a big fat nail is stuck into my shoulder. And thats awesome how you 2 could not have had more different of an experience.

That's one detail I'm afraid I don't recall...I'm not sure the surgeon ever quantified the type of spur removed. Part of the goal of my surgery was to investigate (and repair) a suspected partial tear. In the event I recall nothing was deemed necessary once they could see the (minimal) damage. Empirically the effect of the surgery was very obvious, all the pain I had been suffering as a result of the impingement was gone. Also to PeterD's good PT advice...since I had no tear repair done I could resume active PT immediately and I continued the full recommended course.

Dr. Stephen Paul in Boulder performed my my subacromial decompression in Jan 2009, and 5 years later it continues to be great decision to get it fixed, one I should have made sooner rather than living with the pain (and making it worse). My acromion was a Type 2. It was my first surgery ever and I was dreading recovery.

But it was fine -- no pain killers after day 2, and within a week I was back to pretty normal daily activities, except for a few things (e.g., opening heavy doors). I had to remember to use my left hand/arm instead of right so much. I took 6 months off from climbing to be on the safe side.

More details here:

mountainproject.com/v/acrom…

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