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Subacromial decompression surgery for shoulder pain is not effective
Clinical Question
Should patients be referred for subacromial decompression surgery for shoulder pain?
Bottom line
Whatever you call it—impingement syndrome, rotator cuff disease, bursitis—surgical decompression of the subacromial space in patients with chronic shoulder pain without a history of trauma is not helpful and may be harmful. This guideline group strongly recommends against it. Stick with conservative therapy. 5
Reference
Study design: Practice guideline
Funding: Foundation
Setting: Various (guideline)
Synopsis
This committee attempted to answer one question: Should patients with antero-lateral shoulder pain lasting at least 3 months, without a history of trauma, be considered for surgery aimed at decompressing the subacromial space? The guideline committee was made up of patients, clinicians, and methodologists, none of whom had financial conflicts of interest. They based their recommendations on the results of 2 systematic reviews to assess the balance of patient-oriented benefits, harms, and burdens of surgery as compared with other treatments. Based on this research, the group strongly recommends that surgery be avoided, since it does not produce important improvement in pain, function, or quality of life, and may increase the risk of frozen shoulder.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Practice changing
Until we know who is more likely to experience benefit from shoulder surgery, I will not be referring my patients to Orthopedic Surgery