Arthroscopy offers no benefit in subacromial shoulder pain.
Shoulder arthroscopy is widely used, although its benefits are far from clear. Impingement of the rotator cuff tendons occurs frequently in patients aged >40 years and usually presents as a painful arc. As long ago as 1972, open decompression of the area was proposed, removing osseous spurs, often combined with tendon release and a bursectomy. This is generally now an arthroscopic procedure, frequently undertaken.
A recent multicentre trial that covered 32 hospitals and 51 surgeons in the UK was reported in The Lancet. Eligible patients had subacromial pain for at least 3 months, with intact rotator cuff tendons, and had completed conservative management including exercise therapy and at least one steroid injection. Participants were randomly assigned to arthroscopic subacromial decompression, investigational arthroscopy only (which was a placebo), or no intervention.
Surgical groups had better outcomes from shoulder pain and function compared with no treatment, but this difference was not clinically important. In addition, surgical decompression appeared to offer no benefit over arthroscopy only. These findings bring into question the value of this operation for these indications, of which patients should be aware when offered surgery.
Beard DJ, Rees JL, Cook JA, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): A multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial Lancet 2017 (epub 20 November 2017). https://doi.org/ 10.1016/S0140-6736(17)32457-1
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|Title Annotation:||30 days in medicine|
|Publication:||SAMJ South African Medical Journal|
|Article Type:||Brief article|
|Date:||Feb 1, 2018|
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