Shoulder Impingement Surgery

Good shoulder function is important to your overall health and well-being. When your range of motion becomes limited due to shoulder impingement, you may find it hard to perform common activities of daily living, such as bathing, dressing, or driving a vehicle. Although impingement surgery is effective, shoulder surgery carries a certain level of risk that varies from person to person. Doctors also know that, in many cases, the pain and stiffness of impingement improve with medications and lifestyle adjustments.

After confirming the diagnosis with specific shoulder impingement tests, most orthopedic surgeons will exhaust all nonsurgical options, such as activity modifications, steroid injections, and physical therapy before suggesting impingement shoulder surgery. However, if conservative shoulder impingement treatment fails to relieve the soreness and your functional ability is limited by impingement, shoulder surgery may be your best option.

Before you begin any impingement shoulder treatment, discuss the risks and benefits with your doctor.

Minimally invasive shoulder impingement surgery (also called shoulder arthroscopy or arthroscopic shoulder decompression) is performed by an orthopedic surgeon. Many sports medicine doctors perform the procedure, since the condition is not uncommon in athletes. When choosing an orthopedic surgeon for shoulder impingement surgery, look for experience and board certification.

The procedure can either be open or minimally invasive. Your surgeon will discuss these options with you and recommend a surgical approach based on the extent of your shoulder impingement and your overall health. The arthroscopic (minimally invasive) approach generally is more common.

Shoulder arthroscopy is performed as an outpatient procedure in a hospital or surgical center. The surgeon makes several small incisions in your shoulder and inserts a tiny camera (arthroscope) into the joint. Once your surgeon can see on a camera monitor exactly what is causing shoulder impingement, he or she uses specialized surgical instruments to remove bone spurs, repair damaged tendons, or perform other necessary operations to address the problem.

Open shoulder impingement surgery is performed in a hospital, and you probably will need to stay overnight. Your doctor may opt for the open approach if a shoulder MRI reveals significant degenerative shoulder disease that warrants a more complex surgical repair.

Minimally invasive shoulder surgery for impingement often results in less pain and a quicker recovery time than open surgery. For either type of surgery, you usually will receive a general anesthetic to keep you comfortable and still throughout the procedure. For some medically fragile patients, regional anesthesia may be an option. Ask your surgeon about your anesthesia options well in advance of surgery and share any past problems you’ve had with anesthesia.

While there may be some variation based on where you have surgery, the day of your shoulder arthroscopy will likely include these steps:

• Check in at the outpatient surgery center (or hospital) and complete paperwork.

• Change into a hospital gown and receive an intravenous (IV) line for fluids and medicine.

• Discuss anesthesia with your provider—often a nurse anesthetist. At this point, you may receive a sedative to help you relax while you wait. Be sure to tell your anesthesia provider about any allergies and any previous adverse reactions to anesthesia.

• Visit briefly with your orthopedic surgeon, who will mark up the surgical site with a felt-tipped pen. This is your opportunity to ask any last-minute questions about the procedure and your recovery.

• A nurse or other staff member will transport you to the operating room and the anesthesia provider will start your anesthesia.

• After the surgeon finishes the procedure and closes the incisions, you wake up in a recovery area where a specially trained nurse will be monitoring your vital signs.

• Your nurse will go over your discharge instructions. Be sure you have someone to drive you home, because you cannot drive safely after receiving general anesthesia.

The process for an open shoulder surgery goes much the same way, except you will be transported to a hospital room after waking up instead of being sent home. Specially trained orthopedic nurses and physical therapists will care for you until the doctor says you can go home. Your shoulder may be immobilized in a sling immediately following either type of surgery, but the arthroscopic approach usually lets you get back to full range of motion more quickly due to the smaller incisions.

Minimally invasive shoulder surgery generally carries fewer risks than traditional, open surgery. Less time under anesthesia reduces your risk of an adverse reaction, and smaller incisions mean less postoperative pain. Nonetheless, all surgeries carry certain risks and potential complications. Ask your doctor about your personal risks before consenting to surgery.

The general risks of surgery include:

• Adverse reaction to anesthesia including breathing problems

• Pain due to the surgical incision or IV placement

• Infection

Most shoulder surgeries proceed routinely, but complications can include:

• Damage to the blood vessels or nerves

• Shoulder stiffness or weakness

• Slow-healing incision that requires additional treatment

• Recurring symptoms including pain

You may be able to reduce your risk of complications by:

• Following your pre- and postoperative instructions closely, especially regarding activity restrictions

• Getting help at home for the first few weeks if you are having open shoulder surgery and will not be able to use your arm

• Promptly reporting postoperative symptoms of fever or change in mental status, such as delirium or fainting

• Taking your medications exactly as directed

You may be able to improve your postsurgical comfort and outcome if you prepare for the procedure by:

• Adhering closely to a conservative treatment plan prior to considering surgery

• Setting up your home for recovery, such as adding pillows to your bed to support your arm and placing common objects within easy reach

• Following your postop activity instructions closely—do not exceed activity recommendations.

• Telling your doctor if your pain is not controlled

Before you have surgery, you may want to ask:

• How might this type of impingement shoulder treatment improve my symptoms and quality of life? What results do you see with patients like me?

• Is there a possibility I will need to have this procedure again in the future?

• How can I minimize the scar’s appearance?

• What are the risks of this procedure for me?

• How often and what type of complications do you encounter from this surgery?

• What types of activity restrictions will I be facing, and for how long?

• What types of postsurgical pain management do you use?

• Lastly, ask your surgeon about the quality of care at the surgical center or hospital. It’s important to have surgery at a high-quality facility with a very low rate of shoulder surgery complications.

A little planning and preparation can help your recovery go smoother.

The total recovery period can take several months, depending on the extent of the surgical repair. For arthroscopic shoulder surgery, the recovery time generally takes between one and four months. Extensive open shoulder surgery can take up to a year for full recovery. The recovery period includes physical therapy to regain range of motion and general healing time.

The pain of arthroscopic shoulder impingement surgery usually is minimal. Open shoulder surgery may be more painful due to the larger incision and the more extensive repairs in the shoulder. In either case, you may receive mild oral pain relievers to help manage any postop discomfort.

You will follow up in person with your doctor on a schedule after surgery, but you should call the office immediately if you experience any of these symptoms:

• Fever above 101 degrees Fahrenheit, which can indicate infection

• Change in mental status, such as fainting or delirium

• Extensive reddening and warmth of the skin beyond the immediate surgical incision

• Falling, even if you do not fall on the surgically repaired shoulder

• Foul-smelling drainage from the incision

• Nausea or vomiting

Call 911 for emergency medical assistance if you experience sudden difficulty breathing, as this could indicate a pulmonary embolism.

Shoulder impingement surgery can relieve pain and restore mobility to your shoulder, which in turn should improve your quality of life. You may find yourself able to perform pleasurable activities, including recreational sports that you had given up due to shoulder impingement. Continuing with shoulder exercises to strengthen the shoulder and taking care not to overuse your shoulder will help keep the joint healthy and functional.