Arthroscopic Subacromial Decompression and AC Joint Excision

This operative procedure aims to increase the size of the subacromial space.

Evidence of inflammation or scuffing on the under surface of the acromion, coraco-acromial ligament and on the bursal side of the rotator cuff (“kissing lesion”) indicates the presence of an impingement.

The condition of the acromial surface (A) and the bursal surface (B) are scored on a scale of 1-3. The operation involves the removal of the anterior 1/3 of the acromion and partial resection of the coraco-acromial ligament. The acromio-clavicular joint (ACJ), remains intact unless excision is indicated. The superior AC ligament remains intact so that the joint remains stable.

It must be remembered however that over zealous physiotherapy and repetitive or sustained overhead activities could lead to delayed recovery.

Aims of Physiotherapy

Achieve full range of movement
Improve postural awareness and initiate scapula stability.
Strengthen the rotator cuff
Restore proprioception using open and closed chain activities.
If the rotator cuff is deficient, strengthen anterior deltoid in supine.

Return to Functional Activities

Driving 1 week
Return to work, dependent on the patient’s occupation
Golf 6 weeks, (but not driving range)
Racquet Sports Sport specific training when comfortable Competitive play after 3 months
Lifting As able
It is important to avoid repetitive or sustained overhead activity at or above the shoulder height for 3 months