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Surgical complications related to ASAD are similar to those of other shoulder procedures. They can be separated into complications related to inaccurate or incomplete diagnosis and those related to incorrect technique.

An incomplete diagnosis can occur from failure to recognize and address coexisting pathology such as a labral tear or partial rotator cuff tear. These can be minimized with a thorough preoperative work-up and after in the operating room, a meticulous and complete diagnostic arthroscopy.

The most common technical errors are usually related to excessive or inadequate bone resection. Iatrogenic fractures of the acromion have been reported after aggressive acromioplasty and surgical disorientation. Some series have reported postoperative AC joint symptoms after excessive coplaning during surgery. Inadequate bone resection is most common anteriorly or laterally.

Infections are uncommon and have an incidence of less than 1%. Reflex sympathetic dystrophy is rare but may occur in patients who have reported prodromal radicular symptoms. Postoperative stiffness is a relatively common problem after all shoulder surgery.

Early range of motion and a supervised therapy program are beneficial in order to minimize the risk of permanent stiffness. Operating on a shoulder that is stiff preoperatively may lead to a very stiff shoulder post-op. Performing an ASAD on a patient that has early adhesive capsulitis is a potential complication that can be avoided.

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