Wednesday, 12 Dec 2018

You are here

Surgical Decompression Ineffective for Subacromial Shoulder Pain

Lancet reports that a common surgical intervention, arthroscopic sub-acromial decompression is ineffective compared to arthroscopy or no surgery at all.

A multicentre, randomised, placebo-controlled trial included surgically naive patients who had subacromial pain for > 3 months with intact rotator cuff tendons.  These patients were refractory despite prior exercise therapy and at least one steroid injection. Patients were randomized to receive either A) arthroscopic subacromial decompression, B) arthroscopy only (no removal of bone and soft tissue), or C) no treatment intervention.

The primary outcome was the Oxford Shoulder Score (0 [worst] to 48 [best]) at 6 months.

The study enrolled 313 patients (106 to decompression surgery, 103 to arthroscopy only, and 104 to no treatment).  At 6 months, there was data for 90 patients assigned to decompression, 94 to arthroscopy, and 90 to no treatment.

The Oxford Shoulder Scores did not differ between the two surgical groups at 6 months (decompression mean 32·7 points vs arthroscopy mean 34·2 points). There was little benefit over no treatment (mean 29·4 points). While this was statisticially significant (p=0·0014), such differences were not felt to be clinically meaningful.

There were six study-related frozen shoulders (in two patients in each group) and no other complications.

Surgical intervention for subacromial shoulder pain failed to yield clinically important results and surgical decompression appeared to offer no extra benefit over arthroscopy only. 

These data imply a greater role for conservative management measures when treating subacromial shoulder pain. 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Patients Don't Always Tell the Truth

Sometimes patients withhold information from their doctors, and a new study suggests that as much as 60 - 80% of patients consciously omit information to their doctors, despite knowing this may bear on their health and well-being.

Deprescribing to Battle Polypharmacy

The Gerontological Society of America has published a report calling for deprescribing as a means of managing polypharmacy in the elderly.

Limited Impact of Vitamin D Supplementation

A systematic review of 81 studies on vitamin D concludes that vitamin D supplementation does not prevent fractures or falls, or have clinically meaningful effects on bone mineral density.

Metanalyses specifically looked at studies addressing total or hip fractures, falls, or bone mineral density measured at the lumbar spine, total hip, femoral neck, total body, or forearm.

Steroid Injection Superior to Splinting in Carpal Tunnel Syndrome

Lancet has published a comparative effectiveness study examining the the value of night splints (conservative treatment) vs local injection for patients with carpal tunnel syndrome.

CIRT Trial - Methotrexate Fails at Cardiovascular Prevention

Methotrexate has been shown to reduce cardiovascular (CV) deaths in rheumatoid arthritis (RA) patients. Given that inflammation underlies the pathogenesis of atherothrombosis, Dr. Paul Ridker and colleagues studied the value of low dose methotrexate (MTX) in preventing cardiovascular events.