Synonyms
ASD, SAD, OAD, decompression shoulder, subacromial decompression, rotator cuff, rotator cuff tear, tendinosis calcarea
Definition
So-called subacromial decompression expands the area below the acromion (= sub acromial=shoulder roof), ensuring normal sliding of the rotator cuff underneath. The subacromial acromion is widened in the case of shoulder impingement syndrome. Basically, there are two methods of surgical therapy:
- Arthroscopic subacromial decompression (ASD)
- Open Subacromial Decompression (OSD)
Arthroscopic subacromial decompression (ASD)
Arthroscopic subacromial decompression – ASD – is performed via two small skin incisions as part of a simultaneous arthroscopy (mirroring) of the shoulder joint. The two skin incisions are made above the actual shoulder joint interior. As already mentioned, only two small skin incisions are required for access.
Two accesses are necessary because the so-called optics must be inserted (posterior access) and the surgical instruments must also be inserted (lateral access). The optics is a small camera that displays images of the shoulder on an external monitor. In the context of ASD, surgical instruments can be, for example, electric knives or shavers, which are required to expand the area.
Operative procedure
The procedure is divided into 2 steps: bursoscopy and subacromial decompression
- The so-called bursoscopy is a form of diagnosis. The bursa subacromialis (bursa) is examined and assessed by means of optics. Using the optics, which are advanced from the back of the shoulder under the acromion into the subacromial bursa, it is possible to detect any adhesions, thickening or redness, for example, which ultimately have an effect on the second step, subacromial decompression.
The condition of the rotator cuff can also be assessed by buroscopy. For this purpose, the optics are aligned “downwards”. Rotator cuff tears can be easily detected, since the cause itself lies on the rotator cuff and has grown together with it.
A view “upwards” allows visualization of the acromion under surface. This is the area that is to provide an extension of the subacromial space by partial removal. This partial removal is performed using a shaver, which removes this bone area by rotary cutting movements.
This procedure is performed as part of the 2nd step described below.
- The actual subacromial decompression consists of two sub-steps, soft tissue removal and bone resection. During soft tissue removal, thickened bursa parts (bursa sacs -> see picture) are removed and the soft tissue on the acromion underside (Schlterdach underside) is also removed. This soft tissue removal is performed with a shaver (milling machine).
Since incisions in these areas always bleed and bleeding impairs vision, hemostasis using an electric knife is always necessary to sclerotize bleeding. Bone resection involves milling away the bone on the underside of the acromion. The shaver is also used for this, but the attachment is modified.
During the operation, the acromion was thinned out, and a large portion of the soft tissue and bursa were removed. A widening of the subacromial space can be seen, so that the newly created distance between the acromion and the rotator cuff now allows better sliding movement.
Before the operation, a special X-ray image (outlet view) is taken, in which a constricting spur under the acromion can be seen, which damages the rotator cuff and ultimately leads around a torn rotator cuff. After the operation Same X-ray image after arthroscopic surgery, after the spur has been removed. The cause of the tightness was removed. This operation can be performed using the keyhole technique, i.e. arthroscopy, without large incisions.
