Tuesday, 20 Mar 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. 

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

Add new comment

More Like This

Leflunomide May Sensitize the Insulin Receptor and Have an Anti-Glycemic Effect

An animal model study in the Journal of Endocrinololgy reports the potential use of leflunomide in the control of hyperglycemia in male mice. 

2017 Rheumatology Year in Review

This retrospective review is drawn from the authors collection of the most impactful publications, research and news that occurred in 2017.  In no particular order, here are my top rheumatology advances, news and research reports for calendar year 2017.

Oral Anticoagulation Effective Following Hip and Knee Replacement Surgery

Many protocols call for anticoagulation after total hip or total knee arthroplasty to prevent venous thromboembolism (proximal deep-vein thrombosis or pulmonary embolism), and some reports have suggested a role for aspiring or direct oral anticoagulants as preventative therapy. The NEJM has reported that oral anticoagulation with rivaroxaban (Xarelto) followed by aspirin to be effective prophylaxis.

Calcium and Vitamin D Do Not Increase Cardiac Events/Death

An analysis of the UK Biobank study found no link between calcium/vitamin D supplementation and incident cardiovascular events/deaths in a large prospective study of 475,255 men and women aged 40 to 69 years.

Results published in Journal of Bone and Mineral Research used registry data to identify coded incident hospital admissions for ischemic heart disease (IHD), myocardial infarction (MI), and subsequent death.

Apremilast Continues to Look Good in Behcet's Disease

The 2018 American Academy of Dermatology Annual Meeting features recent findings of a phase III trial of apremilast in active Behçet’s Disease, showing significant reductions in oral ulcers at week 12 for those treated with apremilast 30 mg twice daily.