Subacromial Shoulder Decompression Surgery Not Recommended

A new practice guideline suggests that decompression surgery for adults suffering from atraumatic shoulder pain diagnosed as subacromial pain syndrome (SAPS) is not recommended.

Researchers at Lovisenberg Diaconal Hospital (LDS; Oslo, Norway), McMaster University (Hamilton, ON, Canada), University Hospitals of Geneva (Switzerland), and other institutions participating in a guideline panel that also included patients, clinicians, and methodologists made the recommendation, based on two linked systematic reviews that examined the benefits and harms of subacromial decompression surgery and the minimally important differences for patient reported outcome measures.

The researchers noted that when compared with placebo surgery, decompression surgery did not improve pain, function, or quality of life; in fact, it was more commonly associated with frozen shoulder. The panel therefore concluded that almost all informed patients would choose to avoid surgery, as there is no benefit, but there are harms and it is burdensome. But while decompression surgery should not be offered to patients with SAPS, the researchers said that substantial uncertainty remains as to what alternative treatment is best. The study was published on February 6, 2019, in The BMJ.

“This recommendation addresses the role of surgery for adults with symptoms lasting more than three months, who approach health professionals for treatment,” concluded lead author Per Olav Vandvik, MD, PhD, of LDS, and colleagues. “Clinicians should not offer patients subacromial decompression surgery unprompted, and clinicians, public health care providers, and others should make efforts to educate the public regarding the ineffectiveness of surgery.”

Subacromial pain is the most common (up to 70%) form of shoulder pain, and it can impair the ability to work or do household tasks. Most subacromial pain patients without a history of trauma receive a diagnosis of SAPS, shoulder impingement, or rotator cuff disease. Each of the labels describes similar clinical presentations, but an inconsistency exists about how they should be defined, as well as how they overlap between themselves.

Related Links:
Lovisenberg Diaconal Hospital
McMaster University
University Hospitals of Geneva