Acromioplasty Acromio-clavicular Joint Resection
Another common condition with the shoulder is arthritis of the acromio-clavicular joint. The cartilage between the acromion (the bone on top of your shoulder) and the clavicle (collar bone) becomes damaged, causing the two bone ends to rub against each other and produce pain. The indications for surgery are persistent pain interfering with your activities of daily living, work and/or sports.
Based on current medical knowledge, if surgery is not performed, the problem will most likely continue. With time, the pain may increase in severity. The possibility also exists that the pressure on the tendon will causes further tendon damage, such as partial tearing or even a complete tear, in the tendon.
Treatments other than surgery are available, including just living with the condition, physical therapy exercises, medication or injections.
The Surgery Experience
This type of surgery is completed as an outpatient procedure under general anesthesia. You also will be given an injection of a type of novocaine that lasts 12 to 18 hours to help decrease shoulder pain after surgery.
This surgery is done using arthroscopic technique. Instead of a large incision I use 2-3 small (about 1/2”) incisions. Through 1 incision I insert the arthroscope which lets me look inside your shoulder. The other incisions are used to insert special instruments that allow the removal of scar tissue and bone spurs.
During surgery, Dr. Gartsman will inspect the shoulder joint as well as the ligaments and tendons. He uses small, motorized instruments to remove any inflamed or scarred tissue contributing to the problem, as well as a special instrument to remove that portion of the acromion bone and/or the clavicle that is causing pressure on the tendons. Bone and scar tissue removal increases the space through which the tendons pass and allows recovery in 85-90% of patients.
Following surgery you will awaken in the recovery room with your arm will be in a sling. After surgery to support your arm we use a special sling and an attached ice pack to control the pain and swelling. Nothing can eliminate the pain completely, but medication, sling and the ice pack will control it so that you will be as comfortable as possible.
How successful is the surgery?
This type of surgery is successful about 85-90% of the time. No shoulder operation is 100% successful in every individual but the procedures we perform are reliable and will help restore the potential function in your shoulder. Because of the many variables involved I can make no guarantees other than to assure you I will deliver the very best medical care possible.
Your first office visit is three weeks after surgery so that Dr. Gartsman can examine the surgical incision. He will give you additional instructions for exercises and discuss your allowed activity level. Six weeks after surgery, more vigorous use of the shoulder will be allowed. Office visits then occur three and six months after your surgery, if necessary.
Returning to Work
For most sedentary jobs, Dr. Gartsman recommends two to three days off from work. When you return to work your arm will be sore but you should be able to manage as long as you do no heavy lifting, pushing, pulling or carrying. Work at waist level and 5-10 pounds or lifting can begin one week after surgery, while heavier lifting and work at or above shoulder level starts one to two months
after surgery. You will generally need 3-6 months before recovery is complete and return to heavy lifting or prolonged overhead use may require 6-12 months.
You may enjoy walking, and stationary bicycle riding within one week after
your surgery. Jogging, Stairmaster and regular bicycle riding can start as soon as you feel comfortable, as can gentle golf strokes. Swimming, running, and tennis ground strokes start one to two months after surgery. Return to overhead throwing, tennis strokes and contact sports can require three to six months of rehabilitation, while a full return to competitive, overhead sports require six to 12 full months.
The most common complication from surgery for arthritis of the acromio-clavicular joint involves injury to nerves around the shoulder. These usually go away in two days to six weeks (this occurs in less than 1% of patients). Permanent injury that results in diminished use, function or feeling in the extremity can occur but is exceedingly rare. Infection can occur (1-2% chance), and may require antibiotics by pills or by injection. Rarely, surgery is necessary.
Arthroscopic Subacromial Decompression
AC Joint Resection
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