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.
You may have
general anesthesia during arthroscopy, or you may have
You may go home a few hours after waking up from anesthesia. A
family member or friend should drive you home. In some cases, the doctor may
suggest that you stay overnight for help with pain and for
observation. You will probably need help from friends or family for the first 2 weeks after surgery.
Discomfort after surgery may be relieved by:
With a doctor's approval, you may be able to return to light work
within a few days after surgery even if you are using a sling.
Physical therapy after surgery is crucial for a successful
recovery. A typical rehabilitation schedule includes the following:
When normal shoulder strength and range of motion return, usually
after about 6 to 8 weeks, you can gradually go back to playing sports.
Smoothing may be done for people who:
Also, if you have a rotator cuff tear, you may have
arthroscopic smoothing before open surgery.
Most people who have surgery to smooth the bones and create more
space for the rotator cuff usually have less pain with shoulder
In addition to the general risks of surgery, such as blood loss or
problems related to anesthesia, complications of subacromial smoothing surgery
for rotator cuff disorders may include:
Subacromial smoothing does not always correct the rotator cuff
problem. Things that may cause the surgery to fail include:
Subacromial smoothing using
arthroscopic surgery can usually improve shoulder function
as well as open surgery can but without some of the drawbacks of open surgery. The benefits of arthroscopic surgery for subacromial smoothing
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Beasley Vidal LS, et al. (2007). Shoulder injuries. In
PJ McMahon, ed., Current Diagnosis and Treatment in Sports Medicine, pp. 118–145. New York: McGraw-Hill.
Other Works Consulted
Lin KC, et al. (2010). Rotator cuff: 1. Impingement lesions in adult and adolescent athletes. In JC DeLee et al.,
eds., DeLee and Drez's Orthopaedic Sports Medicine, Principles and Practice, 3rd ed., vol. 1, pp. 986–1015. Philadelphia: Saunders Elsevier.
Murphy RJ, Carr AJ (2010). Shoulder pain, search date August 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
July 10, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
& Timothy Bhattacharyya, MD
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