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Decompression surgery 'may not benefit people with shoulder pain'

Published on 21 November 2017
Decompression surgery 'may not benefit people with shoulder pain'

People experiencing chronic shoulder pain may not actually benefit from a form of surgery commonly used to treat the condition, according to a new study.

Funded by Arthritis Research UK, the University of Oxford-led study has added to the body of evidence suggesting that arthroscopic subacromial decompression surgery may not be the best option for people with shoulder pain.

Limited evidence of clear benefits to surgery
Decompression surgery has become one of the most commonly-performed surgical procedures in orthopaedics. It involves surgical removal of the spur and soft tissue from a part of the shoulder blade to prevent physical contact with the tendons during arm movement, with the aim of curing or reducing symptoms.

However, the evidence for the benefits of this surgery are limited, which is why this study - published in The Lancet - was conducted to investigate further. The outcomes of patients receiving the surgery were compared to those who received no treatment, as well as a third group who were operated on without the bone and soft tissue actually being removed.

In total, 313 patients were involved in the study, with all three groups experiencing similar outcomes regardless of the type of treatment they received. The groups undergoing surgery showed a small benefit compared to no treatment, but no clinically important differences were seen.

Adjusting approaches to treatment
These findings cast further doubt on the benefits of decompression surgery, particularly given that those who received the surgery without having any actual tissue removed experienced similar outcomes - suggesting that any perceived benefits may have more to do with the availability of postoperative physiotherapy, or simply a placebo effect.

The study concluded: "The findings question the value of this type of surgery for these indications and may discourage some surgeons from offering decompression surgery and dissuade some patients from undergoing the surgery."

Lead author David Beard, professor of musculoskeletal sciences and fellow at Kellogg College, said: "The main message from this placebo-controlled study is that arthroscopic decompression shoulder surgery doesn't appear to work in the way that we previously thought. The design of the trial, by having a group of patients not undergoing surgery, also helped show that the surgery may not be as effective as first thought - nonoperative patients were doing nearly as well as those having surgery.

"It would be wrong if decompression surgery were now dismissed out of hand, but practice and decision-making for surgery should now involve greater consideration by both patients and surgeons."

Arthritis Research UK's view
Natalie Carter, head of research liaison and evaluation at Arthritis Research UK, comments: "Painful shoulders account for 2.4 per cent of all GP consultations in the UK, and can make it difficult to work, drive or get dressed. Many people with shoulder pain are treated with, and will respond to, nonoperative treatment alone; however, surgery is often used as a treatment. In 2010, more than 21,000 people had this type of surgery in England - an increase of nearly 750 per cent in ten years.

"This study suggests that other treatments such as physiotherapy can be just as effective as shoulder surgery, and should be taken into consideration with patients considering surgery and could influence the decisions made by health providers.

"Often shoulder pain can be short-lived, but if you’re experiencing shoulder pain which continues for more than two weeks, or gets worse, speak to your doctor or a physiotherapist in case you have a more complex problem."

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