Rheumatoid arthritis and shoulder arthroscopy (subacromial decompression)


So. Surgery. Tomorrow. What am I having done?   A right shoulder arthroscopic decompression.  Sounds fun, right?  Yeah, I thought so too.

When I saw my surgeon a few months ago, her pronouncement was ‘Your shoulder is crap!’ quote.  I loved her for that.  She talks normal person speak.  She said there was loads of cartilage damage,   and moderate AC joint arthritis.

So it would seem that the uncontrolled inflammation has eaten the cartilage, but is still working on the bone.

So a bit of shoulder anatomy.  The shoulder essentially has two joints.  The AC joint (acromioclavicular joint) is the joint where the collar bone (clavicle) and the shoulder blade (scapular) meet.  This joint is covered in cartilage, which allows the joint to move smoothly. The shoulder (AC) joint is held together by a group of muscles and tendons collectively called the rotator cuff.  When all is well, the rotator cuff keeps the ball of the humerous (arm bone) in the socket (glenoid) of the scapula.  This forms the other shoulder joint – the glenohumeral joint.   If there is an injury or tear in the rotator cuff, movement of the shoulder is impaired and painful and there can be instability in the shoulder.

The ball and socket of the shoulder is very shallow, and therefore there is a ring of soft fibrous tissue called the labrum that surrounds the socket, and stabilizes the joint.  The labrum deepens the socket by about 50%, and it is also the attachment point of the biceps tendon as well as the shoulder joint ligaments and the shoulder joint capsule.

So it’s a complicated joint and quite a bit that can go wrong.

The umbrella term for what I have is shoulder impingement syndrome. In my case, it’s a direct result of the inflammation caused by Rheumatoid Arthritis.  Shoulder impingement syndrome is characterised by pain caused by bursitis, inflammation and bone spurs. In my case I have a labral tear as well.  There are often tears in the rotator cuff, but mine appear to be intact.

All of this can cause severe pain.  And believe me, it has. For about three years now, I have been putting up with it.  And while I am terrified of surgery, I can’t wait for this pain to be gone!

So what is an arthroscopic decompression?

The surgery aims to increase the space in the subacromial area, and thereby allow the shoulder joint to function without impingement.

The surgery is relatively minor, it takes about an hour and is done arthroscopically (keyhole surgery).  Usually there are three small incisions , one at the front and two at the back.  The first thing the surgeon will do, is assess the damage inside the shoulder.  The aim is to remove bone and bone spurs at the front of the shoulder (acromion) that is impinging inflamed and damaged tendons, causing the pain.  The main part of the operation will be filing down the bone spurs and removing the damaged, inflamed tissue – the bursa and the synovium.  Both the bursa and the synovium will grow back over time. The hope is that they will grow back but no longer be inflamed. Be ‘normal’.

Sounds good to me.

She’ll also fix the labral tear, and check for other tears in the rotator cuff.

Sometimes the joint between the collarbone and the acromion (the AC joint) needs to be snipped as well.  She will decide when she gets in there.  She will also repair the damage to the biceps long head tendon.  Sometimes this tendon is just cut, as it is not essential to shoulder function.  Because I lift weights and am relatively young, my surgeon will repair the tendon.

Sounds pretty simple, right?

The recovery sounds pretty bad.  Two to four weeks in a sling.  Quite significant pain, but she promises it will be far better in the long run.  And about four months to complete recovery, back in  the gym, doing my normal routine.

I’m a bit concerned as to how I’m going to manage.  I’m on my own, single mother, two kids. But they are old enough to take care of themselves. They can feed and dress themselves and get themselves on the bus to school.  I have the freezer stocked with ready homemade meals.

It will be OK.

There’s really just my fear to deal with.  Irrational fear of anesthetic.  I know it will be fine.  But I can’t wait until I have woken up and it’s all over and done with!



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