Subacromial decompression surgery is a common and generally safe procedure for relieving shoulder impingement symptoms. However, like any surgical intervention, it carries potential risks and complications. While most patients experience significant improvement with proper care, understanding these risks can help individuals make informed decisions and manage their recovery effectively.

This article provides an overview of the potential complications associated with subacromial decompression surgery and tips for minimizing their impact.

Understanding the Risks of Surgery

Subacromial decompression involves removing or reshaping part of the acromion bone to increase space in the shoulder joint and reduce impingement. Though minimally invasive techniques like arthroscopy have reduced complications, risks still exist, including surgical, anesthetic, and post-recovery factors.

Common Risks and Complications

1. Pain and Stiffness

  • Description: Postoperative pain and stiffness are common, particularly in the early recovery period. Pain typically diminishes with time, but stiffness may persist if physical therapy is not followed diligently.
  • Management: Pain can be managed with prescribed medications and cold therapy. Stretching and mobility exercises, as recommended by your physical therapist, help reduce stiffness.

2. Infection

  • Description: Any surgical procedure carries a risk of infection at the incision sites or within the shoulder joint. Symptoms include redness, warmth, swelling, discharge, and fever.
  • Prevention: Proper wound care, keeping the surgical site clean and dry, and taking prescribed antibiotics as directed can minimize the risk of infection.
  • Treatment: If an infection occurs, it may require antibiotics or, in severe cases, additional surgery to address the issue.

3. Bleeding and Swelling

  • Description: Mild bleeding and swelling are normal after surgery, but excessive or prolonged bleeding can indicate a complication. Swelling in the shoulder may lead to discomfort or reduced range of motion.
  • Management: Applying ice packs and elevating the arm can help control swelling. Report significant bleeding to your doctor immediately.

4. Nerve or Blood Vessel Damage

  • Description: The shoulder joint is surrounded by nerves and blood vessels that can occasionally be damaged during surgery, leading to numbness, tingling, or weakness in the arm or hand.
  • Prevention: Surgeons take great care to avoid these structures, and the risk is low with experienced professionals.
  • Treatment: Most minor nerve injuries resolve over time, but severe cases may require additional medical intervention.

5. Incomplete Symptom Relief

  • Description: While subacromial decompression is highly effective, some patients may experience incomplete relief of pain or stiffness, particularly if other underlying conditions (e.g., arthritis or rotator cuff tears) contribute to their symptoms.
  • Management: Follow-up evaluations and additional treatments, such as physical therapy or injections, may be necessary to address residual symptoms.

6. Shoulder Instability

  • Description: In rare cases, removing too much bone during decompression can lead to shoulder instability, affecting the joint’s functionality.
  • Management: A well-balanced rehabilitation program focusing on strengthening the rotator cuff and scapular muscles can help improve stability.

7. Scarring and Adhesions

  • Description: Internal scarring or adhesions can develop in the shoulder joint, leading to restricted movement and pain. This condition, known as adhesive capsulitis or “frozen shoulder,” is more common in individuals with diabetes or prolonged immobilization after surgery.
  • Management: Early mobilization through physical therapy and regular stretching exercises can reduce the risk of adhesions.

8. Blood Clots (Deep Vein Thrombosis)

  • Description: Though rare after shoulder surgery, blood clots can develop in the arm or other areas due to reduced movement post-surgery.
  • Prevention: Gentle movement, staying hydrated, and following your doctor’s activity guidelines can help reduce the risk of clots.

9. Anesthetic Complications

  • Description: General anesthesia or regional blocks used during surgery carry potential risks, such as allergic reactions, nausea, or breathing difficulties.
  • Management: Your anesthesiologist will evaluate your medical history to minimize risks and ensure a safe experience.

10. Reoperation or Revision Surgery

  • Description: In rare cases, additional surgery may be required if complications arise or if initial decompression fails to alleviate symptoms adequately.
  • Management: Proper diagnosis of the underlying cause before surgery and adherence to postoperative care can reduce the likelihood of revision surgery.

Reducing the Risk of Complications

While it’s impossible to eliminate all risks, several steps can help minimize complications and support a smoother recovery:

  • Choose an Experienced Surgeon: Opt for a surgeon with expertise in shoulder arthroscopy and subacromial decompression.
  • Follow Postoperative Instructions: Adhere to guidelines for wound care, activity restrictions, and physical therapy.
  • Communicate Concerns: Report any unusual symptoms, such as severe pain, fever, or redness, to your doctor promptly.
  • Stay Active (with Caution): Early, controlled movement of the shoulder can prevent stiffness and improve circulation while avoiding excessive strain.
  • Attend Follow-Up Appointments: Regular check-ups allow your doctor to monitor healing and address potential issues early.

When to Contact a Doctor

Seek medical attention immediately if you experience:

  • Fever, chills, or significant redness/swelling around the surgical site.
  • Persistent or severe pain that doesn’t improve with medication.
  • Numbness, tingling, or weakness in the arm or hand.
  • Difficulty breathing or symptoms of a blood clot, such as swelling or pain in the arm.

FAQs

  1. How common are complications after subacromial decompression?
    Complications are rare, particularly with minimally invasive arthroscopic techniques. Most issues can be managed effectively with early intervention.
  2. Can shoulder impingement return after surgery?
    In some cases, symptoms may recur if the underlying cause, such as poor posture or repetitive stress, isn’t addressed. Physical therapy and ergonomic adjustments can help prevent recurrence.
  3. How long does pain last after surgery?
    Mild to moderate pain is expected for several weeks but should steadily improve with proper care and therapy. Persistent or worsening pain should be evaluated by your doctor.
  4. What can I do to avoid frozen shoulder after surgery?
    Early physical therapy, gentle stretching, and avoiding prolonged immobilization are key to preventing frozen shoulder.
  5. Is nerve damage permanent?
    Most nerve injuries during shoulder surgery are temporary and resolve within weeks to months. Severe cases are rare and may require specialized care.

Subacromial decompression is a safe and effective procedure for relieving shoulder impingement symptoms. By understanding potential risks and complications, patients can better prepare for surgery, actively participate in their recovery, and achieve the best possible outcome.