Subacromial bursitis and shoulder arthroscopy

Subacromial bursitis and shoulder arthroscopy

Subacromial bursitis is an inflammation of the bursa located below the acromion, the topmost part of the shoulder blade. While it typically serves to lubricate the joint and promote smooth motion, this fluid-filled sac can become irritated and result in pain.

Often caused by repetitive motions, subacromial bursitis is especially common in throwing athletes. Development can also be influenced by age, posture, and traumatic injury.

Treating subacromial bursitis

Treatment begins with reducing and modifying day-to-day activities which aggravate the bursa. Generally supplemented with non-steroidal anti-inflammatory medications (NSAIDs), this allows the shoulder to rest and heal.

Physiotherapy can strengthen weakened rotator cuff muscles, improve posture, and position the shoulder blade to avoid causing further damage. In many cases, this can sufficiently restore function and relieve pain. Corticosteroid injections may be employed to deliver anti-inflammatory medication directly to the bursa.

Surgical treatment for subacromial bursitis is relatively uncommon, but may be considered if symptoms do not resolve after 3-6 months of conservative treatment.

Surgical treatment

Surgical treatment aims to alleviate pain by creating more space below the acromion, allowing the muscles and tendons to move without causing irritation.

Known as subacromial decompression, this procedure is performed arthroscopically. The minimally-invasive approach allows a surgeon to perform the whole procedure through small incisions in the shoulder.

The surgeon accesses the shoulder joint through several small incisions in the shoulder. Specialised tools are then used to carefully shave away part of the acromion bone. The surgeon carefully checks for other causes of inflammation – such as bone spurs – before retracting the tools. If these are present, the surgeon may choose to remove them in the same procedure.

In some cases, the inflamed bursa may be removed entirely. This allows a new, healthy one to grow back in its place.

Indications for arthroscopic decompression

Arthroscopic decompression is typically recommended if the acromion has a curved or hooked shape, rather than a flat one. This shape is believed to increase the likelihood of impingement and resulting inflammation.

Subacromial bursitis can sometimes occur alongside a rotator cuff tear. In this case, the tear is generally the primary pathology and is treated before decompression is recommended.

Suitability and ideal surgical approaches are discussed with Dr Jonathan Cabot at your consultation appointment. As with any surgery, the preferred intervention is determined on a case-by-case basis.

Recovery from arthroscopic subacromial decompression

Many patients can return home on the day of the procedure. A sling is generally required for comfort in the 24 hours after surgery, which can be removed as pain levels permit. Mobilising the shoulder as soon as possible is highly encouraged.

Dr Jonathan Cabot will recommend specific exercises to strengthen the shoulder muscles and encourage return to normal function, which should be assumed as soon as possible after surgery. Complete pain relief is generally achieved 2-4 months after the procedure.