Shoulder Arthroscopy, Subacromial Decompression and ACJ Excision

Indications

Open Rotator Cuff Repair, mri of a complete supraspinatus tear
MRI of a complete supraspinatus tear. Image by RSatUSZ, Wikimedia Commons, CC BY-SA 3.0.
  • Diagnostic arthroscopy for unexplained mechanical symptoms
  • Subacromial decompression is no better than placebo surgery for impingement (CSAW, Lancet 2018)
  • Acromioclavicular joint excision for symptomatic ACJ arthritis
  • Calcific tendinitis not responding to injection or barbotage
  • Biopsy and synovectomy

Position

  • Beach chair or lateral decubitus with traction
  • Beach chair gives a familiar orientation and easy conversion to open surgery
  • Lateral decubitus improves glenohumeral access
  • Controlled hypotension and pump pressure reduce bleeding

Operative Steps

  1. Posterior portal about 2 cm inferior and 1 cm medial to the posterolateral acromion
  2. Anterior portal through the rotator interval
  3. Inspect biceps, labrum, cuff undersurface, subscapularis, glenoid and humeral head
  4. Lateral portal for the subacromial space and bursectomy
  5. Release the coracoacromial ligament and flatten the acromial undersurface
  6. Excise 5 to 10 mm of distal clavicle, preserving the superior and posterior ACJ capsule
  7. Mark landmarks before swelling distorts them
  8. Use a spinal needle to plan portal position

Postoperative Care

  • Sling for comfort, early motion
  • Physiotherapy for range and scapular control
  • Return to most activities by 6 to 12 weeks

Complications

  • Stiffness
  • Infection
  • Axillary nerve injury
  • ACJ instability after excessive resection
  • Fluid extravasation
  • Infection with Cutibacterium acnes
  • Chondrolysis from intra-articular infusions
  • Axillary nerve injury with low lateral portals

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.