Subacromial Decompression 29826

Subacromial impingement xray

Type III acromion picture

Type III acromion

 Arthroscopic subacromial decompression
CPT Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms:

Subacromial Decompression CPT

Subacromial Decompression Indications

 Subacromial Decompression Contraindications

  •  Infection

Subacromial Decompression Alternatives

  • Conservative care (NSAIDs, physical therapy, subacromial injection)

Subacromial Decompression Pre-op Planning

Subacromial Decompression Technique

  • Ensure they have full internal rotation pre-operatively, if not consider Posterior Capsular Contracture as cause of pain and consider posterior capsular release. (Ticker JB, Arthroscopy 2000;16:27-34).
  • Perform Shoulder Arthroscopy
  • Place scope into subacromial space via posterior portal incision. The subacromial space is largest and most easily entered beneath the anterolateral corner of the acromion.
  • Lateral portal under the anterior half and parallel to the acromion.
  • Perform full bursectomy to relieve any sources of crepitation
  • In subacromial space visualize CA ligament, anterior and lateral margins of acromion, AC joint.  Pts with impringement will have fraying of CA ligament
  • Release CA ligament.  BE wary of acromial branch of thoracoacromial artery bleeding, and stop with cautery if it occurs.  Do not release CA ligament in patients with RTC-deficient shoulders.
  • Perform initial acromioplasty using a burr through the lateral portal, then complete acromionplasty with a posterior cutting block technique.
  • Evaluate undersurface of the distal clavicle for impinging osteophytes. Do not violate AC joint. (Fischer BW, Arthroscopy 1999;15:241-8). If impinging osteophytes are present consider Distal Clavicle Resection
  • Consider transverse humeral ligament release(Ruotolo C, Arthroscopy 2002;18:65-75), Distal Clavicle Resection, Biceps Tenodesis or tenotomy based on pre-operative evaluation.

Subacromial Decompression Complications

Subacromial Decompression Follow-up care

  • Post-op: sling, Pendulum ROM exercises
  • 7-10 Days: Check incisions.  Progress with activities as tolerated, PT
  • 3 Weeks: Assess ROM, gradually return to normal activities.  Continue PT as needed. 
  • 6 Weeks: Assess function, ROM.  Continue Home exercise program. 
  • 3 Months: Full normal activities. 

Subacromial Decompression Outcomes

  • 81% good to excellent results at 6-10 years. (Stephens SR, Arthroscopy 1998;14:382).

Subacromial Decompression Review References