SAD

SUB-ACROMIAL DECOMPRESSION-OPEN/MINI OPEN

 

 
Purpose

To decompresss the impingement of the rotator cuff against the coraco-acromial arch ( acromium process, spur, coraco-acromial ligment) and thickened/inflamed bursa.
Indication
Patients with shoulder pan from impingement. Patients may also have an associated acromioclavicular joint degeneration requiring excision. Patients may also have an associated rotator cuff tear, which may or may not, require separate repair.

 
Skin Incisions

Sagittal: this gives the best cosmetic result
Procedure
The deltoid is detached from the antero-lateral aspect of the acromium and split distally to a maximum of 3 cm. The under surface of this region of the acromium is then removed( a Neer type acromioplasty). A limited or full excision of the bursal sac is caried out, depending on the severity of the condition. The deltoid is carefully repaired ( including sutures through the bone)

 
Possible Associated Procedures

Arthroscopy of the gleno-humeral joint
Excision of the acromioclavicular joint
Repair of rotator cuff tear

 

Possible Associated Complications

Infection
Detachment of the repaired deltoid
Nerve injury, e.g suprascapular nerve
Shoulder stiffness

 

 

 

 

 

 

 

SUB ACROMIAL DECOMPRESSION ARTHROSCOPIC
 

Purpose

To decompress the impingement of the rotator cuff against the coraco acromial arch ( acromium process, spur, coraco- acromial ligament) and thickened /inflamed bursa.

 
Indications

Patients with shoulder pain from impingement in which the rotator cuff is intact or where there is a tear not suitable forrepair. Rarely, it may be necessary to convert to an open procedure.

Skin Incisions

Posterior- arthroscope
Lateral- arthroscopic instruments and arthroscope
Anterior- used for gleno-humeral joint assessment and as an outflow portal; or should acromioclavicular joint require excision/or chlectomy.

Procedure

Removal of the antero-lateral ,inferior aspect of the acromiu and the acromial attachment of the coracoacromial ligament with arthroscopic power tools and radiofrequency instruments.

 
Possible Associated Procedures

Arthroscopic assessment of the gleno-humeral joint
Acromioclavicular joint excision
Rotator cuff repair
Biceps stabilisation, or tenodesisMain Possible Complications

Nerve Injury

Failure to completely decompress
After your operation
A sling is applied in theatre and worn for 48 hours. The post operative swelling usually resolves in 24 hours.
The sutures cn be removed after 2 weeks and the physiotherapist will check the range of movement.
4 Weeks post op

Your surgeon will asses the range of passive and active range of movement. If there is no progression in the range of motion from the two week assessment then a referral will be made for increased physiotherapy; an MUA may be considered (or a capsular release) at a later stage.
Neurological function will be assessed.
12 Weeks post op

Assess active and passive range of movement
Assess rotator cuff function
Assess scapulothoracic function
Examine for concurrent pathology
6 Months Post op

Assess active and passive range of motion
Discharge with continuation of physiotherapy or review in 3 monthsprascapular nerve
Shoulder stiffness