- Type
- Keyhole arthroscopic procedure
- Anaesthesia
- General + interscalene block
- Day surgery
- Yes
- Sling
- Comfort sling, 1–2 weeks
- Return to desk job
- 1 week
- Return to manual work
- 4–6 weeks
A note on indications.
Arthroscopic subacromial decompression has a different role in 2026 than it had in 2010. The 2018 CSAW trial and other randomised studies showed that isolated decompression for non-specific subacromial pain produced results no better than diagnostic arthroscopy alone.1 Modern practice has moved accordingly.
Dr Coory performs subacromial decompression selectively, in patients with:
- A clearly identified mechanical cause — a hooked acromion compressing the cuff, an osteophyte impinging on the cuff
- Calcific tendinitis with a deposit being arthroscopically excised
- An adjunct to a rotator cuff repair where access requires it
- Persistent impingement-pattern pain that has clearly responded to a diagnostic subacromial injection and has failed structured physiotherapy
It is not performed as a stand-alone treatment for non-specific shoulder pain.
How it is performed.
Performed arthroscopically under general anaesthesia with a regional block, as day surgery. Standard posterior and anterior portals are made. The arthroscope is first introduced into the joint to inspect for any associated pathology. The arthroscope is then moved to the subacromial space, where:
- Inflamed bursa is debrided.
- Any bone spur on the undersurface of the acromion is shaved smooth (a true acromioplasty).
- The coracoacromial ligament is selectively released where indicated.
Closure with steri-strips and a light dressing. The operation typically takes 30 minutes.
Recovery.
Week 1
- Comfort sling for 1–2 weeks.
- Active and passive range-of-motion exercises from day 1.
- Return to a desk job within a week.
Week 2–6
- Sling discontinued.
- Strengthening progresses.
- Return to manual work at 4–6 weeks.
Rehabilitation protocol.
A written copy of this protocol is provided to your physiotherapist on the day of surgery. Recovery after arthroscopic decompression is typically rapid compared with rotator cuff repair.
Weeks 0–2 — early protection
- Sling for comfort (usually 1–2 weeks).
- Pendular exercises and gentle shoulder range of motion as pain allows.
- Active range of motion for elbow, wrist and hand.
- Ice for 20 minutes every 2–3 hours during the first week.
- No lifting, pushing, pulling or carrying.
- Keep dressings clean and dry; no soaking until wounds are healed.
Weeks 2–6 — progressive mobilisation
- Active-assisted shoulder range of motion progressing to full active.
- Scapula control and posture correction.
- Light strengthening as comfort allows.
Week 6 onwards — return to activity
- Progressive strengthening of rotator cuff and scapula stabilisers.
- Return to manual work at 4–6 weeks.
- Return to sport guided by strength and functional recovery.
View the recovery roadmap for the full rehabilitation journey, or visit For Physiotherapists for protocol requests.
Frequently asked questions.
Why isn't subacromial decompression a first-line treatment any more?
Because the published evidence does not support its use for non-specific shoulder pain. The 2018 CSAW trial showed that isolated decompression produced results no better than diagnostic arthroscopy alone in patients with non-specific subacromial pain. It remains useful where a specific mechanical cause is identified.
When is it still done?
Selectively — where there is a clearly identified mechanical cause, where calcific tendinitis is being excised, or as an adjunct to a cuff repair where access requires it.
Will it help my night pain?
If your night pain is due to a mechanical cause that the procedure addresses, yes. If your night pain is due to undiagnosed rotator cuff disease or another source, decompression alone will not fix it.
How long am I off work?
Desk job within a week. Manual work at 4–6 weeks.
Is there a sling?
A comfort sling for 1–2 weeks is common; no formal immobilisation is required.
References.
- Beard DJ, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW). Lancet. 2018;391(10118):329–338.
- Paavola M, et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement. BMJ. 2018;362:k2860.