Arthroscopic subacromial decompression is a keyhole procedure to create more space in the subacromial area of the shoulder by removing a small amount of bone and inflamed tissue. It aims to reduce impingement pain when the arm is lifted.
Two or three small incisions are made around the shoulder. A camera is inserted to visualise the joint and the subacromial space. Inflamed tissue (bursa) is removed, and the undersurface of the acromion bone is shaved to create more room for the rotator cuff tendons. The procedure usually takes 30–60 minutes.
This operation is considered when shoulder impingement — pain felt when lifting the arm, especially overhead — has not responded to a prolonged course of physiotherapy (typically at least three to six months) and corticosteroid injections. It may also be performed alongside other procedures such as rotator cuff repair.
Structured physiotherapy remains the first-line treatment and is effective for many patients. Corticosteroid injections can provide temporary relief. Activity modification and anti-inflammatory medication may also help. Current evidence suggests that physiotherapy alone produces results comparable to surgery for many patients with impingement.
Pre-assessment includes routine blood tests, a heart tracing, and medication review. Inform your team of any blood-thinning medication. This is usually performed as a day-case procedure. Arrange transport home and support for the first few days.
The aim is to reduce pain when lifting the arm overhead and improve function. Most patients experience improvement over the following weeks to months, though response is variable. The benefit is most reliable when combined with a dedicated physiotherapy programme after surgery.
Temporary stiffness is common and improves with physiotherapy.
Some patients continue to experience symptoms despite surgery.
Expected around the shoulder and may extend down the arm.
Painful stiffness that can develop after surgery and may last many months.
Rare, occurring in approximately 1% of cases.
Very rare damage to nerves around the shoulder.
Usually performed under general anaesthesia with a nerve block for pain relief. The nerve block numbs the shoulder and arm for up to 24 hours. Some patients may have the procedure under regional anaesthesia alone.
A sling is worn for comfort for a few days. Gentle exercises start immediately. Most patients return to desk work within one to two weeks and to driving within two to three weeks. Heavier activities resume at six to twelve weeks. Physiotherapy is essential and should continue for at least three months. Full improvement may take three to six months.
A wound check is usually arranged within two weeks. A follow-up appointment with your surgeon is typically at six weeks. Physiotherapy is arranged from the first or second week post-operatively.
Yes. A decompression creates space but does not repair a torn tendon. If a tear is found during surgery, your surgeon may repair it at the same time.
Improvement is gradual over weeks to months. Some patients feel better within a few weeks; others take three to six months.
Research suggests physiotherapy is as effective as surgery for many patients with impingement. Surgery is usually reserved for those who have not improved with physiotherapy.