In the News
A clinical practice guideline in BMJ recommends that subacromial decompression surgery, also known as shoulder impingement surgery, should no longer be offered to patients, because it has “little or no effect” on pain, function, or quality of life. The surgery also carries significant risks, including major bleeding, deep infections, serious anesthetic complications, venous thromboembolism, and peripheral nerve damage.
An international panel of experts evaluated 22 studies with a total of 5,562 patients and focused on pain, physical function, ability to work and exercise, and quality of life. The panel included orthopedic surgeons, rheumatologists, general practitioners, and patients who had had surgery for shoulder pain.
The panel found that, at one year after subacromial decompression surgery, patients were no better than comparable patients treated with physical therapy, exercise, nonsteroidal antiinflammatory drugs, or steroid injections. In addition to the risk of complications, patients undergoing this surgery typically miss two weeks of work, and full recovery varies from months to years. Postsurgical patients must also avoid heavy lifting for one to three weeks and overhead activities for three months.
The panel concluded: “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.” The panel also stated that “all or almost all patients would place a high value on avoiding even minimal risk of complications and burden from surgery.”
About 25% of adults experience shoulder pain yearly, and it's the third most common musculoskeletal problem. Subacromial pain accounts for 70% of shoulder pain, which can impair the ability to work and do household tasks. Symptoms include pain in the upper arm when lifting, difficulty moving the arm, reduced strength in the arm, and sleep problems due to pain. Read the recommendations at www.bmj.com/content/364/bmj.l294.long.—Carol Potera