Effects Questionable for Shoulder Impingement Arthroscopy

A new study suggests that arthroscopic subacromial decompression (ASD) is no more effective than non-operative alternatives and exercise therapy.

Researchers at the University of Helsinki (Finland), Töölö Hospital (Helsinki, Finland), Lund University (Sweden), and other institutions conducted a randomized, sham controlled trial to compare ASD, placebo diagnostic arthroscopy, and exercise therapy at three public hospitals in Finland. The study participants included 210 patients with symptoms consistent with shoulder impingement syndrome. The main outcome measure was shoulder pain at rest and on arm activity at 24 months, as measured by a visual analog scale (VAS).

None of the patients, hospital staff or the researchers who analyzed the results knew which patient was in each group. The results showed no clinically relevant differences between groups at 24 months follow-up in main or secondary outcomes measures or adverse events. In the comparison between ASD and exercise therapy at 24 months, statistically significant differences were found in favor of ASD in both shoulder pain at rest and on arm activity outcomes, but the differences did not exceed the pre-specified minimal clinically important difference. The study was published on July 19, 2018, in BMJ.

“We should question the current line of treatment, according to which patients with shoulder pain attributed to shoulder impingement are treated with decompression surgery, as it seems clear that instead of surgery, the treatment of such patients should hinge on non-operative means,” said senior author Professor Teppo Järvinen, MD, of the University of Helsinki. “By ceasing the procedures which have proven ineffective, we would avoid performing hundreds of thousands useless surgeries every year in the world.”

The most common diagnosis for shoulder pain that requires treatment is shoulder impingement, and the most common surgical treatment is ASD. Previous studies have also shown that ASD of the shoulder does not alleviate the symptoms of patients any better than physiotherapy. Paradoxically, however, the number of decompression surgeries is increasing significantly, even though solid proof of the impact of the surgery on the symptoms has been lacking.

Related Links:
University of Helsinki
Töölö Hospital
Lund University