Acromioplasty

Acromioplasty is a surgical procedure performed to reshape the acromion in your shoulder. In general, a portion of the acromion is shaved away to make more room for shoulder motion.

Anatomy
Your shoulder is a complex joint composed of bones, muscles, tendons, ligaments, nerves, and blood vessels. The acromion is an important bony structure at the top of your shoulder blade. The connection of the acromion and the clavicle (collarbone) form the joint that serves as the roof of the shoulder. The acromion also serves as the attachment site for arm and chest muscles.

When you move your shoulder, the muscles, tendons, and bursa (fluid-filled sac) should glide smoothly under the acromion. Problems in the shoulder, such as shoulder impingement, bursitis, and tendonitis, prevent normal movement. Acromioplasty is completed to relieve symptoms associated with these conditions and restore shoulder range of motion.

Before the Surgery
Tests needed prior to the procedure may include:

• X-rays
• MRI (magnetic resonance imaging)
• Ultrasound
• MRI (magnetic resonance imaging)

Talk with your doctor about your expected recovery time. You may need to arrange for some help at home while your shoulder heals.

The Day of Your Surgery
Wash your shoulder thoroughly. You should not have any skin irritations or infections at the surgery site.

Arrive at the hospital or outpatient center at least one hour before the scheduled time for your surgery. The nurse will insert an IV (intravenous) line to give you medications and fluids during the surgery.

When you are in the operating room, you will be given medicines to make you relax. Anesthesia may be given to numb the nerves of your shoulder and arm, and you may also "sleep" during the surgery.

During Surgery
Your surgeon may choose one of two techniques for your acromioplasty:

• Arthroscopy involves the use of an arthroscope, which is a small, thin camera. This device allows your surgeon to view the inside of your shoulder on a video monitor. A small opening (portal) is made over the area of the acromium and the arthroscope is inserted. The repairs are completed with small surgical instruments, which are also entered through the portals.
• Open repair is completed with the acromion exposed through a cut in the skin for the surgeon to see inside the shoulder. At this time, open repair is considered the gold standard.

With each procedure, a portion of the acromion will be removed and the remaining bone will be reshaped. Any repairs to surrounding tissues are also completed. Next, the shoulder is closed with stitches or staples and a dressing is applied. Your arm will be placed in a sling to immobilize the shoulder.

After Surgery
You may have some swelling and small bruises on your shoulder, but this should disappear within a few days. Most patients have some pain, but this can be relieved with rest, pain medications, and ice (3 times per day for 20 minutes at a time). For several weeks after your surgery, you will wear the sling to support the shoulder.

Recovery
Typically, physical therapy begins the week following surgery. Your therapist will teach you how to gently stretch your shoulder, regain muscle strength, and how to prevent the problem from coming back.

Full recovery may take 6 months to a year. Generally, the open procedure requires longer to heal than the arthroscopic technique. Your recovery depends largely on your health before the surgery and how well you follow your rehabilitation program. It is very important to complete your therapy program and follow your surgeon's recommendations. This will speed your recovery and decrease your risk of re-injuring your shoulder.

Complications
As with all surgical procedures, there are risks related to acromioplasty. Most patients report good results. Some of the risks include infection, excessive bleeding, poor skin healing, joint stiffness, nerve injury, and blood vessel injury.