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Acromioplasty – Shoulder Surgery for Impingement

Acromioplasty is a surgical procedure on the shoulder in which bone spurs on the acromion are removed to relieve pain and restore freedom of movement.

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Things worth knowing about "Acromioplasty"

Acromioplasty is a surgical procedure on the shoulder in which bone spurs on the acromion are removed to relieve pain and restore freedom of movement.

What is Acromioplasty?

Acromioplasty is a surgical procedure performed on the shoulder. It targets the acromion – a bony projection of the shoulder blade that forms the roof of the shoulder joint. The goal of the procedure is to widen the subacromial space, which is the gap between the acromion and the head of the upper arm bone (humerus). This space contains important structures such as the rotator cuff tendons and the bursa, which can become irritated or pinched when the space is narrowed.

When is Acromioplasty Performed?

The procedure is mainly recommended for patients with shoulder impingement syndrome (subacromial impingement) when conservative treatments such as physiotherapy, pain medications, or corticosteroid injections have not provided sufficient relief over an extended period. Common indications include:

Chronic subacromial impingement syndrome
Bone spurs (osteophytes) on the acromion
Subacromial bursitis that does not respond to conservative treatment
Associated rotator cuff damage

How is Acromioplasty Performed?

Today, acromioplasty is most commonly performed as an arthroscopic procedure (keyhole surgery). The surgeon inserts a small camera and specialized instruments through tiny incisions in the skin. Under direct visual guidance, protruding bone spurs and inflamed tissue – including the inflamed bursa – are removed and smoothed.

Procedure Steps

Preparation and anesthesia (usually general or regional anesthesia)
Insertion of the arthroscopy camera and instruments
Removal of bone spurs and smoothing of the acromion
Removal of the inflamed bursa (bursectomy) if necessary
Wound closure and application of a dressing

Aftercare and Rehabilitation

After acromioplasty, targeted rehabilitation is essential for a successful recovery. The shoulder is typically immobilized in a sling for a few days, after which a structured physiotherapy program begins. This program aims to gradually restore range of motion, strength, and stability of the shoulder. Full recovery can take several weeks to months depending on the individual healing process.

Typical Rehabilitation Phases

Phase 1 (Weeks 1–2): Rest, reduction of swelling, passive range-of-motion exercises
Phase 2 (Weeks 3–6): Active range-of-motion exercises, rebuilding shoulder mobility
Phase 3 (from Week 7): Strengthening of shoulder muscles, return to daily activities and sports

Risks and Complications

As with any surgical procedure, acromioplasty carries certain risks. These are generally lower with arthroscopic techniques compared to open surgery. Possible complications include:

Infection at the surgical site
Bleeding or hematoma formation
Nerve or vascular injury (rare)
Joint stiffness (frozen shoulder)
Incomplete symptom relief or recurrence of symptoms

Outcomes and Prognosis

Acromioplasty shows good results in carefully selected patients. Studies indicate that the majority of patients experience significant pain relief and improved shoulder function. However, the effectiveness of the procedure compared to intensive conservative therapy remains a subject of scientific debate, which makes careful patient selection especially important.

References

German Society for Orthopaedics and Orthopaedic Surgery (DGOOC): Subacromial Pain Syndrome of the Shoulder, AWMF Guidelines No. 033-041 (2021).
Paavola M et al. - Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ. 2018;362:k2860.
Koester MC, George MS, Kuhn JE - Shoulder impingement syndrome. Am J Med. 2005;118(5):452-455.

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