Acromioplasty: Understanding Shoulder Surgery Complications
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Shoulder pain affects millions of people, making it difficult to lift, reach, or sleep comfortably. When discomfort persists, physicians may recommend acromioplasty, also known as shoulder decompression surgery, to create more space around the rotator cuff.
While this procedure aims to relieve pressure, it may also alter the shoulder’s stabilizing structures, which can affect joint stability, cartilage health, and rotator cuff function. This article explores potential outcomes after acromioplasty, including an X-ray case showing post-surgical shoulder instability.
Exploring The Acromioclavicular (AC) Joint And Its Location
The AC joint connects the collarbone (clavicle) to the acromion, a part of the shoulder blade. This small joint supports shoulder movement and stability. The clavicle extends from the neck to the shoulder, where a slight bump appears before the top curve of the shoulder—this raised area is the AC joint. Just beyond it, the acromion forms a vital part of the shoulder structure.
Changes in the AC joint due to arthritis or other factors may cause pressure on the rotator cuff, contributing to pain and stiffness. If physical therapy does not provide sufficient relief, physicians may recommend acromioplasty to reshape part of the bone and address structural concerns.
What Is Acromioplasty, And When Is It Recommended?
Acromioplasty reshapes part of the acromion, a bony projection of the shoulder blade. This procedure creates additional space around the rotator cuff, which may help reduce friction and ease pressure on the tendons.
Physicians may recommend acromioplasty for individuals with impingement syndrome, a condition where the acromion presses against the rotator cuff, contributing to pain and restricted movement. The procedure typically involves removing small areas of excess bone, trimming ligaments, smoothing rough surfaces, and, in some cases, addressing inflamed bursa.
Most acromioplasty procedures use an arthroscopic approach, which involves inserting small instruments through tiny incisions. However, some cases may require an open procedure for greater access. Surgery is generally considered when conservative treatments, such as physical therapy and medications, do not provide sufficient relief.
It may also be an option if impingement leads to tendon damage, which could increase the likelihood of a rotator cuff tear. Although acromioplasty is intended to relieve discomfort, altering the shoulder’s stabilizing structures may affect joint function. Changes to the joint’s natural anatomy could contribute to instability, arthritis, or additional tendon concerns over time.
Conditions Acromioplasty Can Help With
Physicians may recommend acromioplasty for certain shoulder conditions that cause pain and limit movement. By creating additional space in the joint, this procedure may help reduce symptoms associated with the following:
- Shoulder Impingement Syndrome: The acromion presses against the rotator cuff, contributing to pain and restricted movement, especially during overhead activities.
- Rotator Cuff Tendinitis: Inflammation of the rotator cuff tendons may cause pain and weakness, often worsening with repetitive arm movements.
- Subacromial Bursitis: Swelling of the bursa beneath the acromion can lead to shoulder pain, stiffness, and reduced mobility.
- Bone Spurs In The Shoulder: Bony overgrowths near the acromion may irritate surrounding soft tissues, contributing to pain and inflammation.
- Congenital Downsloping Acromion: A naturally angled acromion may narrow the subacromial space and increase the risk of tendon compression and shoulder impingement.
Potential Complications Of This Procedure
Although acromioplasty aims to relieve shoulder discomfort, it may also impact recovery and joint function.
Possible considerations include:
- Infection: Bacteria entering the surgical site may cause swelling, redness, or delayed healing, sometimes requiring antibiotics or additional care.
- Nerve Sensitivity Or Injury: Nearby nerves may become irritated or affected, potentially leading to numbness, weakness, or changes in shoulder movement.
- Blood Clot Formation: Limited mobility after surgery may increase the risk of clot development in the arm or legs, which could contribute to further complications.
- Stiffness And Restricted Motion: Scar tissue or muscle tightness may limit movement, making certain activities more difficult.
- Prolonged Discomfort: Some individuals may experience ongoing pain due to inflammation, nerve irritation, or variations in the healing process.
- Limited Symptom Relief: Symptoms may persist if the procedure does not fully address the underlying concern.
- Scar Tissue Development: Excessive scar tissue around the surgical site may contribute to restricted motion or discomfort.
- Changes To Surrounding Structures: Surgical tools may affect nearby muscles, tendons, or blood vessels, which could influence recovery.
- Frozen Shoulder: Post-surgical immobility may trigger adhesive capsulitis, resulting in joint stiffness and limited range of motion.
What Research Reveals About This Surgical Procedure
A large randomized controlled trial found no added benefit to performing acromioplasty alongside rotator cuff repair. Researchers reported that functional outcomes and quality-of-life improvements remained similar whether or not acromioplasty was included. Additionally, recovery may take longer when this procedure is performed.
Further research suggests that both rotator cuff repair with acromioplasty and rotator cuff repair alone do not consistently lead to better outcomes than physical therapy for rotator cuff tears caused by wear and tear. These findings challenge the assumption that surgery is always the most effective approach.
Acromioplasty remains one of the most common shoulder procedures in the U.S., yet it may alter shoulder mechanics in unintended ways. Instead of reducing stress on the rotator cuff, acromioplasty may increase the force required to maintain shoulder stability by 25% to 30%. Some findings indicate that these changes could place additional strain on the rotator cuff.
How Moving X-Ray Shows Shoulder Problems After Surgery
A moving X-ray can provide valuable insight into shoulder mechanics following an AC joint resection. The video at the top of this post highlights changes in a patient’s collarbone and the space left after the AC joint was removed. This structural change may contribute to shoulder instability during movement.
The X-ray first captures the shoulder in a relaxed position, showing a visible gap where the AC joint once supported stability. As the arm lifts, the gap shifts, revealing altered joint movement. Without the ligaments that previously held the joint in place, the shoulder may experience increased motion, which could place additional stress on surrounding structures.
Research does not consistently support acromioplasty as a necessary addition to rotator cuff repair. Some studies indicate that instead of reducing strain, this procedure may increase the force required to maintain shoulder stability. Acromioplasty also results in permanent changes to joint mechanics, which may influence long-term function.
Reduce Surgery Risks With The Regenexx Approach
Surgery is not the only approach for addressing shoulder discomfort and movement limitations. Procedures using Regenexx lab processes offer a non-surgical option that may help support the body’s natural healing process. These treatments focus on improving function and reducing pain without altering shoulder structures permanently.
Physical Therapy And Rehabilitation
A structured physical therapy program can strengthen the muscles supporting the shoulder, improving stability and mobility. Targeted exercises may reduce impingement symptoms, improve posture, and address movement patterns contributing to discomfort. Manual therapy, stretching, and strengthening support shoulder function without the risks of surgery.
Platelet-Rich Plasma (PRP) Injections
PRP injections use concentrated platelets from the patient’s own blood to support the body’s natural healing process. This approach may help with rotator cuff injuries, tendinitis, and bursitis by delivering growth factors that aid tissue function. Unlike surgery, PRP does not alter stabilizing structures and involves fewer procedural risks.
Explore Less Invasive Alternatives For Orthopedic Conditions
Acromioplasty is one surgical approach for addressing shoulder discomfort, but it is not the only option. Non-surgical approaches—such as physical therapy and procedures using interventional orthobiologics—may offer alternatives that do not alter joint structures. These options are intended to support the body’s natural healing response and may help improve function and reduce pain.
Procedures using Regenexx lab processes, including platelet-rich plasma (PRP) injections, use your body’s own healing agents to address issues such as rotator cuff injuries, impingement syndrome, and joint inflammation. These procedures provide a less invasive option compared to surgery and may be associated with reduced downtime.
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