SUBACROMIAL DECOMPRESSION
This leaflet provides general information to help you understand arthroscopic subacromial decompression (ASAD) for shoulder impingement.
This keyhole procedure makes more room under the "roof" of the shoulder, and is usually a day case.
At the heart of my practice is Shared Decision-Making. Whether we pursue conservative management (Plan A) or surgical intervention (Plan B), the goal is to create a tailored treatment plan that aligns with your lifestyle, values, and functional goals.
Open Surgery
Key Hole
This leaflet provides general information and does not replace individual medical advice.
The Anatomy of the Shoulder Joint
The shoulder is one of the most complex joints in the body, relying on several structures working together:
How the Shoulder Works
Three main bones form the joint:
- Humerus (upper arm bone)
- Clavicle (collarbone)
- Scapula (shoulder blade)
The Four Key Joints
- Glenohumeral Joint – the main ball-and-socket joint
- Acromioclavicular (AC) Joint – collarbone meets shoulder blade
- Subacromial Space – tunnel above the rotator cuff
- Scapulothoracic Joint – shoulder blade glides over rib cage
The Labrum (Stabilising Ring)
- A rim of rubbery tissue that deepens the shallow shoulder socket — like a "bumper" or suction cup that keeps the joint stable and prevents dislocation.
The Rotator Cuff
Four deep muscles keep the ball centred in the socket and let you lift and rotate your arm:
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres Minor
About the Operation
Arthroscopic subacromial decompression (ASAD) is a keyhole day-case operation for impingement. Inflamed bursa and any bone spur are removed from under the acromion (the bony "roof"), increasing the space so the rotator cuff tendons are no longer pinched. It may be combined with a biceps tenodesis, rotator cuff repair or ACJ excision.
Benefits & Logic
The operation aims to:
- Relieve the pinching pain of impingement
- Increase the space above the rotator cuff
- Remove sharp bone spurs to prevent tendon wear
- Diagnostic clarity
- Minimally invasive
The Procedure, Step by Step
The operation, step by step:
- Assessment: a camera examines the joint and subacromial space
- Decompression: inflamed bursa and any bone spur are removed
- Space: the gap above the cuff is increased
- Closure: dissolvable stitches, strips and a sling for comfort
Before, During & After Surgery
Before Surgery
- Fasting: no food for 6 hours, no drinks for 2 hours before
- Smoking: avoid for at least 12 hours before, to aid healing
- Medications: continue as advised by the pre-op team
On the Day
- Admission: check in at main reception, then to your room
- Consultation: meet your surgeon and anaesthetist
- Preparation: timing and instructions are reviewed
Anaesthesia
- General anaesthetic with a nerve block that numbs the arm
- Nerve block alone (awake) if general anaesthetic is unsuitable
Recovery & Results
Recovery is a partnership. The timeline below is a guide — your physiotherapist and I will adapt it to you — this shared decision-making process ensures you are fully informed and involved in your care.
Recovery Milestones
- Sling: for comfort, briefly
- Gentle exercises: begin immediately
- Recovery: most do well by 3–4 months
- Full recovery: may take up to 12 months
Results
Most patients get good relief. A trial of physiotherapy over several months is usually recommended before surgery is considered.
After Surgery — In the First Weeks
- Sling: for comfort only, removed early
- Pain Relief: start at home; take regularly for the first few days
- Wound Care: dressings changed at 24–48 hours; showering after 3–5 days
- Physiotherapy: gentle exercises immediately; ice twice daily
- Follow Up: 2–6 weeks post op to monitor progress
Watch the Surgery Videos
For more information you can watch procedure videos at: www.youtube.com/c/ProfBijayendraSingh
Watch on YouTubeRisks & Complications
Uncommon, but possible:
- Anaesthetic: complications are rare
- Infection: fewer than 1 in 1000; treated with antibiotics
- Stiffness: mild stiffness is common, improves with physiotherapy (slower with diabetes)
- Pain: common early, settles over the weeks; an injection helps if it persists
- Nerve: minor, temporary irritation in about 5%
- Failure to Improve: 90% patients report good to excellent outcomes, a small percentage may have ongoing pain and may require further injection or surgery
Return to Activities
This can be extremely variable and discuss with the surgeon. These are just guidelines.
Desk work 1–2 weeks; driving once safe and out of the sling; sport is staged — your physiotherapist will guide the timeline. A member of the team will discuss your specific plan. Driving: 2–4 weeks when safe. A member of the team will discuss your specific plan.
Recovery Timeline & Sleeping
⚠ Red Flags — When to Seek Urgent Help
Fever, spreading redness or discharge from the wound, worsening pain, or numbness and a cold hand — seek urgent assessment.
If you experience any of the above, contact the practice, your GP, NHS 111, or attend your nearest Emergency Department.
Key Points to Remember
- Makes more room under the acromion
- Physiotherapy is tried first
- Usually a day case
- Most people get good relief
Questions You May Wish to Ask
- When can I take the sling off?
- When can I drive and return to work?
- How much improvement can I expect?
- What happens if I don't have surgery?
Book or Enquire Directly at Each Site
| LIPS Healthcare London | 0203 870 9996 | singh.admin@lips.org.uk |
| Spire Alexandra Chatham | 01634 662866 | alexandraselfpaypsc@spirehealthcare.com |
| Practice Plus Gillingham | 01634 969045 | Private.gillingham@practiceplusgroup.com |