Shoulder Decompression Surgery: Recovery, Risks, and Complications

Recovery times for shoulder decompression surgery can vary, but most improvement tends to occur between 3 and 6 months after the procedure.¹Arthroscopic Shoulder Decompression. Cleveland Clinic website. http://my.clevelandclinic.org/services/orthopaedics-rheumatology/treatments-procedures/arthroscopic-shoulder-decompression. Accessed September 14, 2016. Many people are able to make small shoulder movements relatively early in recovery. For example, a person might be able to use the affected arm when eating or getting dressed two weeks after surgery, even though the shoulder has not regained its full function.

Compared to people who have open decompression surgery, people who have arthroscopic decompression surgery tend to have less pain during the initial days following the procedure and a faster recovery.¹Arthroscopic Shoulder Decompression. Cleveland Clinic website. http://my.clevelandclinic.org/services/orthopaedics-rheumatology/treatments-procedures/arthroscopic-shoulder-decompression. Accessed September 14, 2016.

The recovery process will include exercises and stretches to reduce swelling and stiffness.¹Arthroscopic Shoulder Decompression. Cleveland Clinic website. http://my.clevelandclinic.org/services/orthopaedics-rheumatology/treatments-procedures/arthroscopic-shoulder-decompression. Accessed September 14, 2016. A physical therapist can teach a patient exercises and stretches to perform at home.

Risks and Complications for Decompression Surgery

Potential risks and complications for arthroscopy and open surgery include:

• Chronic shoulder pain
• Chronic shoulder stiffness
• Damage to blood vessels or nerves
• Infection (risk is reduced for arthroscopic surgery compared to open surgery)

One possible complication for open surgery is damage to the deltoid muscle, which facilitates arm movements away from the body. A benefit of arthroscopy is not cutting the deltoid muscle.

People who develop notable stiffness and pain after a subacromial [sub-ah-kro-me-al] decompression procedure may be diagnosed with frozen shoulder.

See Frozen Shoulder Symptoms

When decompression surgery includes removing part of the acromion, a procedure called acromioplasty [ah-kro-me-o-plas-ty], additional complications can also occur, including:²Canale S, Beaty J. Campbell’s Operative Orthopaedics, Twelfth Edition. Philadelphia, PA: Elsevier Mosby; 2013.

• Hematoma, which is swelling caused by blood collecting limited area
• Seroma formation, which is a pocket of fluid that can develop in a tissue or organ after surgery
• A rupture of the biceps tendon or an acromion fracture.²Canale S, Beaty J. Campbell’s Operative Orthopaedics, Twelfth Edition. Philadelphia, PA: Elsevier Mosby; 2013.

These complications are uncommon. Patients are advised to talk to their surgeons about individual risks.

When Decompression Procedure Does Not Work

While subacromial decompression can often relieve the symptoms of shoulder impingement, it does not work in about 10% to 25% of patients.³Pillai A, Eranki V, Malal J, Nimon G. Outcomes of Open Subacromial Decompression after Failed Arthroscopic Acromioplasty. ISRN Surgery. 2012;2012:806843. doi:10.5402/2012/806843. As cited in Hawkins R, Plancher K, Saddemi S, Brezenoff L, Moor J. Arthroscopic subacromial decompression.Journal of Shoulder and Elbow Surgery. 2001;10(3):225–230. These people might experience chronic shoulder pain and impairment.⁴Dopirak R, Ryu RK. Management of the failed arthroscopic subacromial decompression: causation and treatment. Sports Med Arthrosc. 2010;18(3):207-12.

Below are several reasons subacromial decompression might not be successful:

• An incorrect diagnosis. Shoulder impingement is sometimes mistaken for other conditions, such as frozen shoulder. An accurate diagnosis prior to surgery is critical.

  See Diagnosing Shoulder Impingement

• The patient does not follow postsurgical instructions. Pain and stiffness can result if the patient does not follow his or her recommended rehabilitation program.²Canale S, Beaty J. Campbell’s Operative Orthopaedics, Twelfth Edition. Philadelphia, PA: Elsevier Mosby; 2013.
• Too little bone was removed. Surgery may not relieve symptoms if not enough bone tissue was removed from the acromion. Insufficient bone removal tends to occur more frequently in arthroscopic acromioplasty, compared with an open surgery acromioplasty.²Canale S, Beaty J. Campbell’s Operative Orthopaedics, Twelfth Edition. Philadelphia, PA: Elsevier Mosby; 2013.

See Diagnosing Frozen Shoulder

In some cases, patient expectations for post-surgical recovery can be too high. The shoulder may never feel exactly the same as it did before shoulder impingement occurred. Patients and doctors should have a frank discussion about what surgery can accomplish.

See Shoulder Pain: Is it Shoulder Impingement?

Revision surgery
If an acromioplasty surgery is unsuccessful, a surgeon and patient may consider a second acromioplasty. However, the outcomes for second procedures are varied. Between 10% and 75% of patients report they are content with the results from a revised acromioplasty procedure.⁵Rockwood CA, Matsen FA. The Shoulder Fourth Edition. Philadelphia, PA. Saunders Elsevier; 2009.