What it is
Subacromial decompression is an arthroscopic procedure that removes inflamed tissue and smooths bony prominences to reduce compression of the rotator cuff and bursa. It is considered when structured rehabilitation has not restored comfortable function.
Most benefit from a strong rehabilitation plan after surgery. The procedure does not repair the rotator cuff.
What happens when it occurs
Small instruments debride bursal tissue and may shave a spur. Range and motion of the arm increase as the swelling subsides. Strength and control progress to restore overhead use.
Common causes and risk factors
- Persistent subacromial pain despite rehabilitation
- Bursal irritation and mechanical impingement symptoms
- Overhead work with poor scapular control
Who is most affected
Adults with ongoing painful arc and night pain after a strong trial of conservative care.
Typical symptoms pre op
- Pain in the painful arc, night pain, and pinching when reaching behind the back
When to seek care
If pain persists and blocks function after rehabilitation and injections.
How we diagnose
History, clinical tests, and imaging where indicated. Decisions weigh function and response to prior treatment.
Management
- Short period of protection and swelling control
- Range and scapular control drills
- Progressive strength for the cuff and scapula
- Return to work and sport by criteria
Rehabilitation milestones
Phase 1 weeks 0 to 2: swelling control, gentle range, sling for comfort as needed.
Phase 2 weeks 2 to 6: progressive strength, scapular control, bike and walks.
Phase 3 weeks 6 to 12: overhead tolerance, work and sport drills.
Phase 4 months 3 to 6: return to full activity after testing.
Readiness to progress
- Wound healed and swelling controlled
- Strength symmetry within 90 per cent
- Overhead tasks completed without next-day pain
Long-term care
- Maintain strength and good movement patterns
- Advance overhead loads steadily
- Plan workloads during busy weeks
Australia snapshot
- Arthroscopic day surgery is widely available
- Used after strong conservative care for persistent subacromial pain
- Rehabilitation access is broad in metropolitan areas
Latest insights
Treat the mechanics as much as the tissues. Strength and control drive long-term outcomes.
Return to overhead work follows the criteria in combination with adhering to specific dates.
