Neck & Shoulder

What It Is

Shoulder arthroscopy is another name for keyhole shoulder surgery. Common arthroscopic shoulder procedures include rotator cuff repair, removal or repair of the labrum, repair of ligaments, removal of inflamed tissue or loose cartilage, and repair for repeated shoulder dislocation (AAOS, n.d.). Shoulder decompression surgery can also be done this way (Hull University Teaching Hospitals NHS Trust, 2025).

An arthroscopy is a type of procedure that orthopedic surgeons use for inspecting, diagnosing and repairing problems inside of the joint. The word derives from two Greek words that mean joint and to look, so it literally means to look inside of the joint. A small camera is inserted into the shoulder joint by a surgeon. The camera will then display pictures on a video screen for the surgeon to use for guiding miniature surgical instruments (AAOS, n.d.).

Since the instruments are thin, the surgeon doesn't need to make large incisions. This results in less pain for those having the procedure done, as well as shortening the amount of time it takes to recover and return to normal activities. Shoulder arthroscopy has been performed since the 1970s, and it has made diagnosis, treatment and recovery from surgery easier and faster than was once thought possible. Improvements happen every year as new techniques and instruments are developed (AAOS, n.d.).

Causes

Injury, overuse and age-related wear and tear are responsible for most shoulder problems (AAOS, n.d.). Long-standing shoulder problems such as shoulder impingement and rotator cuff tears may lead to shoulder surgery if they don't respond to non-surgical treatment. In impingement, the tendons and a fluid-filled cushion (bursa) in the space under the acromion (the bony tip of the shoulder blade) can get pinched and become inflamed with movement (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).

Shoulder Arthroscopy Anatomy

The shoulder joint is made up of the "ball and socket". The socket is ringed by a rim of strong cartilage called the labrum, which makes the socket slightly deeper, adds stability and cushions the joint. In some sports injuries the labrum can be torn, and labral tears can be repaired arthroscopically (AAOS, n.d.). Four tendons, called the rotator cuff, surround the joint and help keep the ball centred in the socket. Between the rotator cuff and the acromion is the bursa, which helps the tendons glide smoothly when you move your arm (AAOS, n.d.). The space under the acromion, where these tendons and the bursa sit, is called the subacromial space, and this is where decompression surgery is done (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).

Undergoing an Arthroscopic Shoulder Procedure

Before you have the operation, a member of the anaesthetics team will speak with you about your options for anaesthesia. Shoulder arthroscopy may be performed using a regional nerve block to numb the shoulder and arm. The medicine is injected into the base of your neck or high up on the shoulder, as this is where the nerves are located. As well as numbing the arm during surgery, a nerve block helps to control pain for several hours after the surgery is completed (AAOS, n.d.).

Many surgeons combine the nerve block with a light general anaesthetic, because patients can become uncomfortable having to stay in one position for the length of the procedure. Most arthroscopic procedures take less than 2 hours, but the length of the surgery depends on what your surgeon finds and what repairs are needed (AAOS, n.d.).

In a subacromial decompression, the surgeon releases a ligament at the front of the acromion and shaves some bone from underneath the acromion. This enlarges the space above the shoulder joint so the tendon can move more freely (Hull University Teaching Hospitals NHS Trust, 2025). If there is rotator cuff tendon damage, the surgeon may repair the tendon during the arthroscopy (AAOS, n.d.).

Your surgical team will give you their own instructions for after the operation; always follow these.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

Things You Should Know About Shoulder Decompression Surgery

Surgery should be the last case scenario. Shoulder surgery is usually only recommended when a painful condition has not responded to non-surgical treatment such as rest, physical therapy, and medicines or injections (AAOS, n.d.). A large UK study (the CSAW trial) found that people who had a decompression operation did no better than people who had a keyhole operation where the surgeon only looked inside the shoulder without removing any bone, and only slightly better (not by a meaningful amount) than people who had no surgery (Beard et al., 2018). This is worth discussing with your surgeon before deciding on surgery.
Shoulder surgery can be painful. If a nerve block is used, it numbs the arm and helps control pain for several hours after surgery (AAOS, n.d.), and it wears off within the first few days (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.). It is normal to feel some pain as it wears off; take the painkillers the hospital gives you as prescribed (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.). You can expect some pain and discomfort for several weeks (AAOS, n.d.).
Lying flat may be uncomfortable at first, and some people are more comfortable sleeping propped up in the first days after surgery (AAOS, n.d.). It may take around 3 months for the inflammation in your shoulder to fully settle (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).
Sling: after a decompression on its own, a sling is often only needed for a few days, but if you have a rotator cuff (tendon) repair your recovery will take longer. Your surgeon will tell you how long you need to wear a sling (AAOS, n.d.; Hull University Teaching Hospitals NHS Trust, 2025).
Exercises and physiotherapy: keeping the shoulder moving is very important to prevent it becoming stiff (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.). Follow the exercises and physiotherapy plan your surgical team gives you, including when to start.
Recovery time: the shoulder usually takes about 3 months to improve significantly, and improvement can continue for up to 6 to 12 months (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.; Hull University Teaching Hospitals NHS Trust, 2025). Recovery from more complicated repairs, such as a rotator cuff repair, can take several months longer (AAOS, n.d.).
Driving: you must not drive while wearing a sling (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.). Discuss when you can drive again with your consultant.

How to Recover from Shoulder Decompression

Always follow your own surgical team's instructions; the points below are general.

1. Rest and Gentle Use

Take time to allow your shoulder to recover. One NHS hospital leaflet advises using your arm as pain allows below shoulder height, avoiding repetitive or sustained overhead activity for 3 months and heavy lifting for at least 4 weeks (Hull University Teaching Hospitals NHS Trust, 2025). Avoid painful movements unless advised by your physiotherapist or surgical team.

2. Ice

Ice can be helpful to reduce pain and swelling. Wrap a bag of ice or frozen peas in a damp towel and apply it for 10 to 15 minutes; this can be repeated every 3 to 4 hours. Protect your dressings from getting wet with a plastic bag (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).

3. Physical Therapy

Once your surgical team agrees, I can support the rehabilitation plan your surgeon and physiotherapist give you, with hands-on work and exercise to ease stiffness and rebuild the movement and strength in your shoulder. See the My Approach tab for how I work.

Rehabilitation is important if you are to get the most out of your operation (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.). Your physiotherapist or rehabilitation therapist will focus on restoring normal movement and strength in the shoulder, following your surgeon's plan.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Steroid injection: an injection of a steroid medicine into or around the shoulder is one of the non-surgical treatments that may be tried to reduce inflammation before surgery is considered (AAOS, n.d.).
Anti-inflammatory medicines: medicines that reduce inflammation are another non-surgical option a doctor may discuss (AAOS, n.d.).

How I can help (see the My Approach tab)

Exercise and hands-on care for shoulder pain, before or after surgery
Easing the neck, upper back and shoulder blade muscles
A graded programme to restore movement and strength, within your surgeon's plan

Tips

Try to avoid a lot of repetitive or sustained overhead movement, such as racket sports or hedge trimming, while your shoulder recovers; these can take longer to become comfortable (Hull University Teaching Hospitals NHS Trust, 2025).
Keep your shoulder moving as advised to help prevent stiffness (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).
If you find that you are suffering from a loss of movement and strength, or your shoulder is not improving as expected, seek the advice of your surgical team or another medical professional for a proper evaluation and treatment plan.

Treatment

My Approach

After keyhole shoulder surgery, your surgeon's plan sets the rules: how long you wear a sling, which movements are allowed and when strengthening starts. What was done inside the shoulder matters, because a tendon or labrum repair needs much longer protection than a decompression on its own. I work inside those limits and need your surgeon's okay before any hands-on treatment. Please bring your discharge notes or rehab guidelines.

Early On

Easing the neck, upper back and other shoulder, which work overtime while your arm is protected
Keeping the elbow, wrist and hand moving
Gentle lymphatic drainage for swelling, keeping away from the cuts until they've healed
Shoulder blade setting and the gentle movements your team has given you

As It Heals

Gentle scar work once the cuts have fully healed
Hands-on work for the shoulder blade and upper arm muscles, and gentle joint mobilisation within the range you've been cleared for
Gentle holds for the rotator cuff and shoulder blade muscles, then light band work below shoulder height
Later, overhead and gym-based strength work for your job or sport, once your team agrees

If the shoulder gets more painful as we add work, we scale back. Increasing pain, redness, heat or fever around the cuts needs your surgeon or doctor promptly.

What to Expect

Typical Course

Typical course: Once your surgeon agrees, most people come once or twice a week at first, then weekly, then less often. The shoulder usually takes about 3 months to improve significantly and can keep improving for 6 to 12 months; a rotator cuff repair can take several months longer, following your surgical team's plan.

What I Focus On

Working Within Your Surgeon's Plan

Compensation Relief

Scar & Shoulder Mobility

Shoulder Blade Control

Return to Strength

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Shoulder arthroscopy. OrthoInfo. Available at: https://www.orthoinfo.org/treatment/shoulder-arthroscopy/ (Accessed: 7 October 2026).
Hull University Teaching Hospitals NHS Trust (2025) Arthroscopic subacromial decompression. Available at: https://www.hey.nhs.uk/patient-leaflet/arthroscopic-subacromial-decompression/ (Accessed: 7 October 2026).
The Royal Orthopaedic Hospital NHS Foundation Trust (n.d.) Subacromial decompression (SAD). Available at: https://roh.nhs.uk/services-information/shoulder-and-elbow/subacromial-decompression (Accessed: 7 October 2026).
Beard, D.J. et al. (2018) 'Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial', The Lancet, 391(10118), pp. 329-338. doi: 10.1016/S0140-6736(17)32457-1

Massage therapy · Kitchener–WaterlooShoulder Arthroscopy

What It Is

Causes

Shoulder Arthroscopy Anatomy

Undergoing an Arthroscopic Shoulder Procedure

Self-Care & Treatment

Things You Should Know About Shoulder Decompression Surgery

How to Recover from Shoulder Decompression

1. Rest and Gentle Use

2. Ice

3. Physical Therapy

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Early On

As It Heals

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooShoulder Arthroscopy

What It Is

Causes

Shoulder Arthroscopy Anatomy

Undergoing an Arthroscopic Shoulder Procedure

Self-Care & Treatment

Things You Should Know About Shoulder Decompression Surgery

How to Recover from Shoulder Decompression

1. Rest and Gentle Use

2. Ice

3. Physical Therapy

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Early On

As It Heals

Typical Course

References

Related Conditions

Shoulder Decompression Surgery

Acromioclavicular Joint Separation

Biceps Tendon Tear at the Elbow

Biceps Tendon Tear at the Shoulder

Book a session