Subacromial decompression (SAD) surgery is a procedure designed to relieve pain caused by impingement of the rotator cuff tendons in the shoulder. This condition occurs when the tendons or bursa (a fluid-filled sac that reduces friction) in the subacromial space become irritated and inflamed, often due to repetitive overhead movements or shoulder injuries. Subacromial decompression aims to alleviate this pain by removing or reshaping the structures that cause impingement, allowing for improved function and reduced discomfort.

In this guide, we will cover everything you need to know about subacromial decompression, from the procedure to the recovery process, and how Palms Physiotherapy & Allied Health can support your rehabilitation journey.

Subacromial Decompression Surgery: Procedure, Recovery, and Rehabilitation

What is Subacromial Decompression Surgery?

Subacromial decompression is a common shoulder surgery aimed at reducing the pain associated with shoulder impingement syndrome. During the surgery, the surgeon removes or reshapes the acromion (a bony projection of the shoulder blade) and the coracoacromial ligament, which are responsible for compressing the rotator cuff tendons or the bursa.

This surgery is typically recommended when conservative treatments such as rest, physical therapy, corticosteroid injections, and medications have not provided relief from shoulder pain.

The Subacromial Decompression Surgery Procedure

1. Pre-Surgical Preparation

• Diagnostic Evaluation: The surgeon will conduct a physical examination and may use imaging studies such as X-rays or MRIs to assess the condition of the shoulder joint and the extent of impingement.

• Pre-Operative Physiotherapy (Pre-Hab): Physiotherapy before surgery can help strengthen the muscles around the shoulder joint and improve flexibility, aiding in faster recovery post-surgery.

2. Surgical Procedure

• Anesthesia: The surgery is typically performed under general anesthesia or regional anesthesia (nerve block), depending on the patient’s needs.

• Incision: The surgeon will make small incisions around the shoulder to access the subacromial space. In some cases, an arthroscope (a small camera) is used to guide the procedure, known as arthroscopic subacromial decompression.

• Bony Reshaping or Removal: The surgeon will remove or reshape the acromion bone and/or the coracoacromial ligament to enlarge the subacromial space and reduce friction on the rotator cuff tendons.

• Bursa Removal: If necessary, the surgeon may also remove the inflamed bursa.

• Duration: Subacromial decompression typically takes 30 to 60 minutes, depending on the complexity of the case.

3. Post-Surgical Care

• Pain Management: After surgery, patients will be given pain relief medications to manage discomfort. Ice packs are often recommended to reduce swelling in the first few days.

• Hospital Stay: Most patients are able to go home the same day of surgery, although a short hospital stay may be required if the surgery is more extensive.

Recovery Timeline After Subacromial Decompression Surgery

Immediate Post-Operative Phase (Days 1–7)

• Sling Usage: Patients are usually advised to wear a sling for the first few days to protect the shoulder while it begins to heal.

• Pain and Swelling Control: Ice, pain medications, and anti-inflammatory drugs will help manage swelling and discomfort.

• Gentle Movement: Patients may begin gentle range of motion exercises, often under the guidance of a physiotherapist, to prevent stiffness.

Short-Term Recovery (Weeks 1–6)

• Sling Use: The sling may be worn for 1–2 weeks, depending on the surgeon's instructions, to prevent unnecessary shoulder movement during healing.

• Physical Therapy: Physiotherapy begins within the first week to help restore shoulder movement and reduce the risk of stiffness. Gentle range of motion exercises will be introduced.

• Follow-Up Appointments: The surgeon will monitor recovery and ensure there are no complications, adjusting the rehabilitation program as needed.

Long-Term Recovery (Months 1–6)

• Gradual Return to Function: Over the next several months, physical therapy will focus on restoring strength and mobility in the shoulder. More advanced strengthening exercises will be introduced to rebuild muscle around the shoulder joint.

• Functional Training: Once strength and motion are restored, therapy will progress to functional training, helping you return to daily activities, work, or sports.

• Return to Activity: Most patients can return to light activities within 3–6 months and may fully return to sport or more demanding tasks after 6 months, depending on their progress.

Rehabilitation After Subacromial Decompression Surgery

Phase 1: Early Rehabilitation (Weeks 1–6)

• Focus: Pain management, reducing swelling, and gentle range of motion.

• Exercises:

  • Pendulum exercises: Gentle movements to help the shoulder regain mobility without strain.

  • Passive range of motion (PROM): Assisted shoulder movements to prevent stiffness while allowing healing.

  • Ice therapy: To reduce swelling and manage pain post-surgery.

Phase 2: Active Rehabilitation (Weeks 6–12)

• Focus: Restoring mobility, increasing range of motion, and beginning gentle strengthening.

• Exercises:

  • Active range of motion (AROM): Shoulder movements performed independently without assistance.

  • Isometric exercises: Strengthening exercises designed to activate muscles without overloading the joint.

  • Stretching: To maintain flexibility and prevent shoulder tightness.

Phase 3: Strengthening and Functional Training (Months 3–6)

• Focus: Rebuilding shoulder strength, restoring normal shoulder function, and increasing endurance.

• Exercises:

  • Progressive strengthening: Gradual strengthening using resistance bands and light weights to build shoulder muscle strength.

  • Functional exercises: Exercises to restore the ability to perform daily activities, such as reaching, lifting, and overhead movements.

  • Sport/Activity-Specific Rehab: For athletes or individuals with physical job demands, rehabilitation will focus on safely returning to sport or physical labor.

How Palms Physiotherapy & Allied Health Can Help

Pre-Habilitation Services

• Strengthening Exercises: Pre-surgical physiotherapy focuses on strengthening the shoulder and improving range of motion to help with a quicker recovery.

• Education: We provide education on the surgical process, the recovery timeline, and post-surgery expectations to prepare you mentally and physically.

• Postural Training: We guide you in improving posture and muscle balance, which can reduce the risk of impingement following surgery.

Post-Operative Rehabilitation

• Individualized Rehab Plans: After surgery, we develop a personalized rehabilitation program tailored to your specific needs and recovery goals.

• Pain Management: Techniques such as manual therapy, ice therapy, and ultrasound therapy are used to manage pain and swelling.

• Strengthening and Mobility: Gradual strengthening exercises help restore shoulder strength, while mobility exercises prevent stiffness and improve function.

• Functional Training: We help you regain the ability to perform normal activities, from work tasks to recreational activities.

• Sports-Specific Rehab: For athletes or those with physically demanding jobs, we help you safely return to your sport or occupation after recovery.

Frequently Asked Questions

1. How long will it take to recover from subacromial decompression surgery?

Recovery time varies, but most patients experience significant improvements within 3–6 months. Complete recovery and return to full activity can take up to a year.

2. Will I experience full pain relief after the surgery?

Most patients experience significant pain relief following surgery, particularly if impingement was the primary cause of pain. However, some patients may experience residual discomfort or stiffness, which can be managed with ongoing rehabilitation.

3. Can I return to work after subacromial decompression surgery?

For desk-based jobs, patients may return to work within 2–4 weeks. For physically demanding jobs, a return to full duties typically takes 3–6 months, depending on recovery.

4. Do I need to wear a sling after the surgery?

Yes, a sling is usually recommended for the first 1–2 weeks to protect the shoulder while it heals. Your surgeon will provide specific instructions on when to begin using the shoulder without the sling.

5. What are the risks associated with subacromial decompression surgery?

Although rare, potential risks include infection, nerve injury, stiffness, or recurrence of impingement. Your surgeon will discuss these risks in detail before the procedure.

Reputable Australian Resources

• Health Direct – Shoulder Surgery: https://www.healthdirect.gov.au/shoulder-surgery

• Better Health Channel – Shoulder Surgery: https://www.betterhealth.vic.gov.au/shoulder-surgery

• Australian Physiotherapy Association: https://australian.physio

This comprehensive guide to subacromial decompression surgery provides valuable insights into the procedure, recovery timeline, rehabilitation, and the role of Palms Physiotherapy & Allied Health in your recovery. Whether you're preparing for surgery or are in the midst of rehabilitation, we're here to support you every step of the way.