Subacromial Smoothing and Acromioplasty for Rotator Cuff Disorders

Surgery Overview

Surgery may be used to treat a rotator cuff disorder if the injury is very bad or if nonsurgical treatment has failed to improve shoulder strength and movement sufficiently. Subacromial smoothing involves shaving bone or removing growths on the upper point of the shoulder blade (acromion). It removes damaged tendon and bursa from the joint. The surgeon may also remove small amounts of bone from the underside of the acromion and the acromioclavicular joint (acromioplasty). The goal is to take away roughness while keeping as much of the normal supporting structures as possible. This surgery creates more room in the subacromial space. With more space, the rotator cuff tendon is not pinched or irritated and can glide smoothly beneath the acromion.

Subacromial smoothing, acromioplasty, and rotator cuff repair may be done using arthroscopic surgery or open surgery.

• Open-shoulder surgery involves making a larger incision in the shoulder, to open it and directly view the repair.
• Arthroscopy uses a thin viewing scope called an arthroscope that is inserted into a joint through a small incision in the skin. Then the surgeon will remove loose fragments of tendon, bursa, and other debris from the shoulder (debridement). Other instruments are then arthroscopically inserted to shave the bone or remove growths. This type of surgery is usually done on an outpatient basis.

You may have general anesthesia during arthroscopy, or you may have a regional nerve block.

• If a nerve block alone is done, you may be awake. You will not feel any pain. But you may feel a sensation of pulling or tugging during the procedure.
• At the start of the procedure, regional nerve blocks are sometimes used along with general anesthesia to help limit pain after surgery.