My last blog discussed the AC (acromioclavicular) joint and why it might be contributing to your neck pain. This time I’m setting my sites on elective shoulder surgery.
The AC joint can also undergo surgery if thought to be contributing to the impingement of the rotator cuff. The surgery is termed acromioplasty, and it is typically performed along with the repair of rotator cuff tears. It involves cutting the ligaments and shaving down part of the acromion, which is one of the two bones that comprise the AC joint.
Acromioplasty and Clinical Outcome
Does acromioplasty lead to a better clinical outcome? A high-level study set out to answer this question. The study randomized patients into one group where a rotator cuff tear was repaired and another where the surgeon added an acromioplasty. The result was that there was no outcome advantage to shaving down the bone and cutting these important ligaments.
Budoff et al in 2016 in another study demonstrated that removing the AC joint increases the forces placed on the rotator cuff.
Please review the video below, which demonstrates the marked instability of the shoulder following surgical resection of the AC joint.
Patient Who Underwent Acromioplasty for Biceps Tendon Tear
AB is a patient I saw two months ago who had undergone such a procedure with devastating consequences.
AB is a 54-year-old yoga instructor who had a surgical repair for a left biceps tendon tear. At the time of surgical repair, the surgeon elected to perform an acromioplasty and in so doing made her shoulder unstable. AB presented with a six-month history of left shoulder pain and weakness with restriction in range of motion. On physical examination and upon dynamic ultrasound of the shoulder, the AC joint was grossly unstable. This severely impacted AB, who was no longer able to perform her yoga postures let alone teach yoga. We are cautiously optimistic about her outcome with us as she will be undergoing ultrasound-guided platelet injections next week.
If you are scheduled for elective shoulder surgery, please know that there are short- and long-term consequences of surgery. When an acromioplasty is performed, the shoulder can become unstable and a new set of problems and limitations occurs. A Centeno-Schultz Clinic board-certified, the fellowship-trained physician will provide a comprehensive evaluation, review imaging, and discuss regenerative treatment options with stem cells and/or platelets. Do yourself and your family a favor and undergo an evaluation prior to proceeding with any elective orthopedic surgery.
