Surgery of Limited Clinical Benefit for Subacromial Shoulder Pain
TUESDAY, Nov. 21, 2017 -- For patients with subacromial shoulder pain, outcomes are better with arthroscopic subacromial decompression and investigational arthroscopy only, although the difference versus no treatment is not clinically important, according to a study published online Nov. 20 in The Lancet.
David J. Beard, D.Phil., from the University of Oxford in the United Kingdom, and colleagues randomized 313 patients with subacromial pain for at least three months with intact rotator cuff tendons in a 1:1:1 ratio to arthroscopic subacromial decompression, investigational arthroscopy only (placebo), or no treatment. Patients were followed up at six months and one year after randomization.
The researchers observed no significant difference in the mean Oxford Shoulder Score between the two surgical groups at six months (32.7 points with decompression versus 34.2 points with arthroscopy; mean difference, −1.3 points [95 percent confidence interval, −3.9 to 1.3; P = 0.3141]). A small benefit was seen for both surgical groups over no treatment (mean 29.4 points; mean difference versus decompression, 2.8 points [95 percent confidence interval, 0.5 to 5.2; P = 0.0186]; mean difference versus arthroscopy, 4.2 points [95 percent confidence interval, 1.8 to 6.6; P = 0.0014]); these differences were not clinically important. Six study-related complications occurred, all of which were frozen shoulders.
"The findings question the value of this operation for these indications, and this should be communicated to patients during the shared treatment decision-making process," the authors write.
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Posted: November 2017
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