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This website is under development - The information contained on this site is for guidance only and is not intended for self diagnosis or self treatment. This will not replace professional medical advice or consultation. Always seek the professional advice of a qualified health care provider like your doctor or specialist before embarking on  any treatment. If you have a problem please consult your doctor or specialist.
Arthroscopic stabilisation    Reverse Replacement    Arthroscopic Subacromial Decompression
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Investigations
If symptoms do not settle with simple measures like activity modification, use of anti-inflammatory tablets and physiotherapy then your GP may refer you to a specialist. After examination, investigations like x-ray and/or ultrasound scan may be requested if not done earlier. These investigations usually give adequate information about the bone, joint and tendon structures around the shoulder. In some instances, these may highlight a new problem like deposit of calcium in tendons or even a tear in the tendon which may require treatment. If all conservative measures fail, then surgery may be considered.

Operation
The aim of the operation is to create more space for the tendons to glide, so as to avoid pinching of the tendons during arm movements. This is achieved by releasing the taut ligament and shaving the prominent bone spur to enlarge the space (subacromial space). This can be done by arthroscopic technique and is called arthroscopic subacromial decompression. (ASD). It is also possible to release the arthritic AC joint by this method if needed.

The operation is usually performed as a day case procedure under general anesthetic. One may supplement this with a nerve block at neck or using local anaesthetic around the wound and inside the joint. To perform the operation, you will be turned to your ‘good-side’ such that the affected sided in on the top.  Gentle traction will be applied to the arm to help
the pass various instruments needed to perform the operation.

The shoulder joint is visualized by introducing the telescope via a small stab incision in the back of the shoulder. Sterile saline is pumped into the shoulder under pressure to distend the joint. To assess the inside of the shoulder, a further stab incision may be placed in the front of the shoulder. The quality of the tendon is checked from inside the joint. The subacromial space above the tendon is then entered and the tendon visualized from ‘above’.

The ligament is then released to expose the bone spur and the prominent bone is shaved. This is done by introducing instruments via an additional stab incision on the side of your shoulder. This space is then washed thoroughly with sterile saline to clear the bone debris as much as possible. In addition, a partial bursectomy is done to get rid of the inflammed bursa. Any additional problems which may be encountered during the operation – like repair of torn tendon, removal of outer end of collar bone or release of the calcium deposit may be carried out.

The wound is closed with sutures and water resistant dressing is applied. This is covered with a further layer of pressure dressing. The arm is then placed in a sling. You will be given information regarding wound care and information regarding various exercises you need to do.
Physiotherapy will be arranged if required.

Impingement lesion - early stage with tight space

Bone cuts started after clearing the ligament

Bone cuts completed with space nearly 9 mm. (Bone burr is 5.5 mm)