Acromioplasty

Surgery may be used to treat a rotator cuff disorder if the injury is very bad or if nonsurgical treatment has not improved shoulder strength and movement enough.

Subacromial smoothing involves shaving bone or removing growths on the upper point of the shoulder blade (acromion ). It removes damaged tendon and bursa from the joint. The surgeon may also remove small amounts of bone from the underside of the acromion and the acromioclavicular joint. (This is called acromioplasty.) The goal is to take away roughness while keeping as much of the normal supporting structures as possible. This surgery makes more room in the subacromial space. With more space, the rotator cuff tendon is not pinched or irritated. It can glide smoothly beneath the acromion. But not all experts agree these procedures will help.

Subacromial smoothing, acromioplasty, and rotator cuff repair may be done using arthroscopic surgery or open surgery.

• Open-shoulder surgery involves making a larger incision in the shoulder, to open it and directly view the repair.
• Arthroscopy uses a thin viewing scope called an arthroscope. The scope is inserted into a joint through a small incision in the skin. Then the surgeon will remove loose fragments of tendon, bursa, and other debris from the shoulder. (This is called debridement.) Other tools are then inserted through the incision to shave the bone or remove growths. This type of surgery is more common than open surgery and often doesn't need a hospital stay.

You may have general anesthesia during arthroscopy, or you may have a regional nerve block.

• If a nerve block alone is done, you may be awake. You won't feel any pain. But you may feel some pulling or tugging during the procedure.
• At the start of the procedure, regional nerve blocks are sometimes used along with general anesthesia to help limit pain after surgery.

Smoothing may be done for people who:

• Have severe pain and impaired shoulder function that has not responded to a few months of conservative treatment.
• Are older adults with severe rotator cuff tears and whose main problem is pain, not weakness.
• Do not wish to have more extensive surgery to repair a rotator cuff tear.

Also, if you have a rotator cuff tear, smoothing may be part of rotator cuff repair surgery.

Surgery to smooth the bones and create more space for the rotator cuff may lead to less pain with shoulder movement. But not all experts agree that this procedure will help.