Shoulder Arthroscopy

Arthroscopic Acromioplasty/Mumford Procedure

(For Shoulder Impingement Syndrome/Chronic RTC tendonitis)

The tip of the scapula (shoulder blade) forms the roof of the shoulder joint is also known as the Acromion.  Normally, the tendons of the shoulder (the Rotator Cuff) and a fluid-filled bursa sac have plenty of room underneath the Acromion. They glide freely in this space and it allows for a full range of motion. Overuse of the shoulder may lead to damage of the tissues underneath the Acromion process. The tendons and bursa may thicken and then pinch against the bone and/or the coraco-acromial ligament, causing irritation and pain.  This is referred to as “impingement syndrome”.  Athletes who participate in sports that have repetitive overhead movements or people whose work involves performing repetitive shoulder movements or overhead movements are susceptible to shoulder impingement.  Some patients have anatomic variation of the acromion (an over hanging tip) and are more prone to this problem. Impingement can also occur where this bone meets the collarbone (clavicle) at the acromioclavicular or AC joint. Occasionally there are significant spurs at the AC Joint, and like a hooked acromion, the cuff is “impinged” upon by the spurs. The AC joint can become arthritic, injured (as in a shoulder separation), or worn by repetitive motion like weight lifting or become cystic (a condition know as osteolysis of the clavicle). It too can be a source of pain.

Figure 1: Inflamed RTC	Figure 2:Spur and Bursitis
Figure 3: Abnormal AC Joint

Treatment:

If the problem has failed to improve with non-surgical methods and when the problem relates to an overhanging acromion, calcified acromial-clavicular ligaments, or a thickened bursa, arthroscopic surgery can help. Through the arthroscope Dr Reznik can remove any damaged tissue, increase the sub-acromial space and clear the inflamed bursa. This procedure is called an “Acromioplasty” and is done on an out-patient basis. When the AC joint is the source of pain, the spurs, arthritic surface, cysts and softened bone can also be removed arthroscopically. This is known as a “Mumford procedure” (resection of the distal clavicle). The choice of procedure depends on the problem you have and in some cases, both are needed to relieve the persistent symptoms of shoulder pain.   

Figure 4: Spur Removal	Figure 5: Smoothing the Distal Clavicle

Acromioplasty/Mumford Recovery Plan

Diet: You may resume a regular diet when you return home. Most patients start with tea or broth adding crackers or toast, then a non-spicy sandwich. If you become nauseated, check to see if one of your medications is upsetting your stomach, most narcotics can. If your stomach feels acidy, try Tums, Zantac or Pepcid AC to settle it and drink some clear liquids.

Lungs: After surgery you are encouraged to deep breathe and cough frequently (at lease 3-4 times per day). This will reduce mucous from building up in your lungs, and will reduce the risk of developing a post anesthetic pneumonia.

Pain Control: Take medication as prescribed by Dr Reznik.  Please call our office with any questions regarding your medication.

Sling:  It is recommended that patients wear the sling when going out for the next 3 weeks. .This will help to alert others to avoid the affected arm during this healing period.

Driving:  Patient cannot drive until they are off all pain medications, completely out of the sling, and can easily place hands at 12:00 position on the steering wheel and can move hands freely from the 9:00 – 3:00 position.

Returning to Work: Most patients performing sedentary or low demand work can return to work within 7 to 10 days. They will still have restrictions on lifting (usually 5 lbs), repetitive and overhead use. Patients performing medium work that may require some light lifting may return in about 3-4 weeks. Patients with higher demand ocupations with infrequent repetitive arm use will need at least 6-8 weeks. Heavy laborers or those with frequent repetitive or overhead work (as in manufacturing or construction) will need a minimum of 3-4 months and then a work conditioning program prior to returning to work.

Note:  Most patients see 80% of their improvement by 4 months with the remainder occurring over the first year after surgery.

Airline Flights: Patients may fly 2-3 weeks after surgery on short flights (up to 2 hours) but in general, should wait 6-8 weeks for longer flights. You should get up and walk frequently to avoid blood clots and take an aspirin (unless allergic).

Blood Clots:

Patients at high risk for blood clots include:

• Those with long car or train commutes

• May be overweight

• Have a history of having cancer

• Females on birth control pills

• Males over the age of 40 

These patients should be taking 1 aspirin per day for 6 weeks after surgery unless allergic to aspirin.

Physical Therapy:

Physical Therapy: Vital to your recovery of good shoulder function is a graduated activity and exercise program to increase muscle strength and motion. You will begin simple exercises the day of surgery. Your physical therapy will begin 3-4 days after surgery.  The physical therapist will guide you in your shoulder rehabilitation program. It is very important for you to start therapy when recommended.

To avoid complications, postoperative follow up appointments with your physician are also required to monitor your progress. Blood clots are rare after shoulder surgery. Patients should be up and walking as soon as comfortable. Leg and foot motion is encouraged several times during each day and they should be done every day for the first 3-6 weeks post-op to maintain blood flow and help prevent blood clots.

Page 2: Post-Operative Exercises

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