This is a keyhole operation that aims to relieve the pain you feel from impingement and tendinopathy. There is some controversy regarding the efficacy and mechanism of action of this operation when performed a sole procedure in patients with an intact rotator cuff. It is important to recognise that some patients may improve without surgery over time and with good physiotherapy.
As a sole procedure therefore, this operation is recommended only when non-surgical measures, such as an injection and a good course of exercise-based physiotherapy have failed to cure your problem. However, the procedure is often carried out alongside another keyhole shoulder surgical procedure in order to improve visualisation and access to the areas that require treatment. A common example of this would be as part of an arthroscopic rotator cuff repair or arthroscopic excision of the acromioclavicular joint.
The operation is performed under general anaesthesia and a regional nerve block. After your joint has been inspected, the arthroscope is passed into your subacromial space (the space above your rotator cuff tendons and below the acromion process of your shoulder blade. The inflamed soft tissue of the bursa is then cleared. Removal of the bursal tissue is thought to clear pain-sensitized nerve endings from your subacromial space. It also clears the view so your surgeon can inspect and treat your acromion bone, your acromio-clavicular joint (above) and your rotator cuff tendons (below). Often patients have a spur, or a hook of bone, at the front of their acromion and a thickened and frayed ligament at the front. In some patients, these cause rubbing against your rotator cuff tendons, so any spur or thickened ligament tissue is shaved back to a smooth surface using a high-speed burr. As well as increasing the space in your shoulder (decompression), the raw bone surface is then able to release growth factors into your shoulder that improve tendon healing.
Below is a photograph of the exposed underside of the acromion bone. The radiofrequency instrument has been used to clear the inflamed bursal tissue sbefore this photograph was taken. The dotted red line shows the spur, which is then resected using a shaver in the next image. This leaves more space for the rotator cuff tendons and a smooth freshened bone surface on the acromion (final image).
View of a typical acromion spur from within subacromial bursa. The inflamed bursal
tissue has been removed using the radiofrequency instrument. Note the tight space
between the acromion above and the rotator cuff tendons below
A high-speed burr is then used to resect the acromial spur
The bone resection is complete and the subacromial space is decompressed
You will normally go home a few hours after your operation. Please take your prescribed painkillers regularly for the first few days and start them before your nerve block wears off. You will be given a sling, but you can discard this after a few days. Please begin begin your rehabilitation as soon as you can. You can take down any bulky padded dressings on day 2 after surgery, but keep your wounds covered with the waterproof dressings for 12 days. Showering is fine after four days with dressings on.
As no structure is repaired or reconstructed in a decompression, there is no need for a period of protection after a decompression. We therefore ask you to try to get your shoulder moving soon after your operation. Your physiotherapist will help you regain range of motion and control of your shoulder. Once you have achieved this, then you can focus on regaining strength.
Patients vary in their recovery after surgery, but in general you can expect to return to:
Office work after three weeks for some, but other may still be too sore
Light physical work after 8 weeks, but some may find this too sore for a while longer
Heavy labour or overhead sport may take 18 weeks
Driving will take 3-8 weeks for most patients
Overall this operation works well, but it can take a while to recover:
By six weeks, 60% of patients will have noticed a significant improvement and most will be comfortable during daily activities. however, certain movements will still be restricted and uncomfortable. Do not worry if you remain sore at this point: it can take a while longer to recover from this operation.
By six months, 90% feel their shoulder is better, although some patients take even longer to benefit.
Arthroscopic shoulder surgery is generally very safe, but specific risks of subacromial decompression include:
Stiffness (5%) which occasionally requires further surgery
Lack of benefit (approx. 10%) - remember, it can take 9 months for full benefit to be realised after this operation.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
BMI The Princess Margaret Hospital
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