Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release.
Summary
This procedure involves using a small camera and instruments inserted through tiny cuts in the shoulder to relieve pressure and pain caused by certain shoulder injuries. It includes trimming a bone spur and releasing a ligament to improve shoulder movement.
Purpose
This procedure is typically performed to treat shoulder impingement syndrome, which can cause significant pain and limit shoulder movement. The goal is to create more space in the shoulder joint to reduce friction and inflammation, leading to improved function and pain relief.
Indications
Patients with persistent shoulder pain and impingement symptoms that do not respond to conservative treatments like physical therapy or medications. Conditions such as subacromial impingement syndrome, rotator cuff tears, or bursitis warrant this procedure.
Preparation
Patients may need to fast for several hours before surgery and might need to adjust certain medications as instructed by their doctor. Preoperative assessments may include physical exams, X-rays, or MRI scans to assess the shoulder's condition.
Procedure Description
- Anesthesia: The patient is given regional or general anesthesia.
- Incisions: Small incisions are made around the shoulder.
- Arthroscope Insertion: A tiny camera (arthroscope) is inserted into the shoulder joint.
- Viewing and Treating: Instruments are inserted to remove bone spurs, smooth the acromion bone, and release the coracoacromial ligament.
- Closure: Incisions are closed with stitches or sterile adhesive strips.
Tools used include an arthroscope, specialized surgical instruments, and possibly a fluid pump to expand the joint space.
Duration
The procedure typically takes around 1 to 2 hours, depending on the complexity.
Setting
It is usually performed in a hospital or outpatient surgical center.
Personnel
A team of healthcare professionals including an orthopedic surgeon, a surgical nurse, and an anesthesiologist will be involved.
Risks and Complications
- Common risks: Infection, bleeding, or temporary pain and stiffness.
- Rare risks: Nerve damage, blood clots, or failure to relieve symptoms, requiring further surgery. Management of complications typically involves medications, physical therapy, and, rarely, additional surgery.
Benefits
The expected benefits include relief from shoulder pain, improved shoulder function and mobility, and quicker return to daily activities. Most patients notice improvement within a few weeks post-surgery.
Recovery
Post-procedure care includes managing pain with medications, using ice packs, and following specific physical therapy exercises. Recovery time can vary; however, most patients can return to normal activities within 3 to 6 months. Follow-up appointments are necessary to monitor progress.
Alternatives
Non-surgical treatments like physical therapy, corticosteroid injections, or medications may be options. These alternatives might offer temporary relief but may not address the underlying issue as effectively as surgery.
Patient Experience
During the procedure, the patient will be under anesthesia and will not feel pain. Postoperatively, they may experience discomfort and swelling, which can be managed with pain medications and ice. Physical therapy will aid in regaining full range of motion and strength in the shoulder.