A comprehensive guide to subacromial decompression surgery

The condition and diagnosis of shoulder impingement

The shoulder is a ball and socket joint surrounded by a group of muscles and tendons called the rotator cuff. These keep the shoulder joint stable and start the shoulder movements. The rotator cuff contains four tendons: the supraspinatus, infraspinatus, teres minor and the subscapularis.

The rotator cuff passes through a narrow channel in the shoulder joint underneath a bony part of the shoulder blade called the acromion. Some people naturally have a narrower channel or have an acromion that is more hooked. This can cause the bone to squeeze and rub the rotator cuff as it passes through this space. In turn this leads to inflammation and pain when the arm is lifted or rotated. 

This problem is known as ‘impingement’. Some people find the pain may ease with time but a significant number need surgery to increase the width of the bony channel, remove the inflammatory tissue, and slow down the fraying or tearing to the trapped tendon.

This surgery is performed under a light general anaesthetic. Sometimes the anaesthetist also gives a ‘nerve block’ to the arm and shoulder. This numbs the nerves for a short time to ease the pain after surgery and to speed up your initial recovery, allowing you to get going faster, without the risks of medical complications. 

The surgeon will perform the keyhole (arthroscopic) procedure via 2-3 very small cuts (portals). Each portal is only about 3-5mm long, through which specialised instruments - including a telescopic camera and a bone shaver - are guided. They then widen the tight channel removing bone spurs and inflammatory tissue to enable the tendon to glide more smoothly along its normal path.

The operation takes approximately 45 minutes and most patients can leave hospital on the day of surgery.

Before proceeding to surgery, you will need diagnostic imaging such as an MRI to confirm the extent of your impingement and any other associated issues. Your surgeon will discuss the condition, treatment options and plans with you at your consultation. 

You will also attend a pre-assessment appointment at the hospital to ensure you are safe to proceed with surgery. It is recommended that you organise to be driven home after your surgery and that you receive support to help you for the first few days after leaving the hospital.

Most patients go home the same day but may need a chaperone to go home with and stay with them for the first 24 hours after surgery. Patients have a sling to wear but this is for comfort only and patients are usually encouraged to undertake early range of movement exercises as pain allows. These may be limited by the swelling in the shoulder caused by the operation in the first two weeks after surgery. 

Your consultant will recommend the best follow-up routine and for regular physiotherapy to help a gradual and progressive return to pain-free mobility. In some cases, full recovery can take up to 4-6 months.

Risks of complications with shoulder decompression

Shoulder decompression surgery is considered a low risk surgery, with few potential complications though these include bleeding, infection or nerve damage - though these complications occur in fewer than 1% of patients and will also be mitigated by selecting the right hospital to manage your recovery. Some stiffness, known as frozen shoulder is possible, however should only last a few weeks at most.

How to judge the best surgeon and hospital for you

Generally, it is reasonable to expect that a fellowship trained specialist consultant shoulder surgeon who undertakes a significant volume of procedures each year is likely to give you a good outcome from your surgery. In general the higher the volume of shoulder decompression surgeries a surgeon performs each year, the greater their expertise will be.

From a hospital perspective, a dedicated orthopaedic ward (with only screened elective orthopaedic patients), senior resident doctors, dedicated specialist nurses and physiotherapists, and a dedicated pain control team are desirable to carefully manage your post-operative care and pain, and identify potential complications early.

Hospitals vary considerably in the way postoperative complications are dealt with - both clinically and financially - so this is worth understanding further prior to self funding.

Hospitals collect two main types of information from patients: direct reviews and outcome scores. At Compare my Care, we look carefully at reviews and outcome data before guiding you to a hospital and surgeon.

Outcome scores - Patient Reported Outcome Measures (PROMS) and Patient Reported Experience Measures (PREMS) - capture the effectiveness of treatment patients received over the longer term, as opposed to their experience in hospital. Hospitals often collect this data both before and after your surgery, to make sure you are getting better after your shoulder surgery.

When choosing between providers and finding the best hospital for your shoulder decompression, it's of course important to carefully consider both the surgeon level and hospital level data along with the overall experience, and the long term outcomes of each procedure performed.

The price of arthroscopic subacromial decompression surgery ranges from £3,000 to nearly £7,000 with the biggest difference factor being the hospital you select. This figure generally consists of hospital costs, surgeons fees, anaesthetic fees and occasionally extra imaging and implant costs. 

What's more, depending on the hospital in question, the price quoted on a hospital's website could be a guide price (and subject to variation). Typically it won’t include other aspects of your treatment such as the initial diagnostic work up.

Compare my Care works by analysing surgeon and hospital volume and performance data, each hospital's facilities and CQC ratings, and available patient experience information to help patients find the best private healthcare providers for their care. 

Our experienced concierge team will work with you to arrange an initial consultation with the surgeon at your selected hospital.

Please note: Compare my Care does everything possible to secure a fixed price for each procedure, but individual medical needs may result in diagnostic and treatment variation which can impact costs.

‘Protect my Care’ is a unique ‘cash-back' insurance policy provided by Compare my Care. It was created to give patients additional protection and peace of mind when paying for their own surgery - and comes at no extra cost to the patient.

All surgeries come with risks but in the hands of a super-specialist surgeon these can be reduced further. However, in the rare event that a repeat surgery is needed within 12 months, patients will be refunded the cost of their original procedure - to spend as they see fit.

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