Patients who undergo subacromial decompression surgery for shoulder impingement syndrome experience equally little pain when compared to a placebo surgery group, according to the Finnish Shoulder Impingement Arthroscopy Controlled Trial.
The study included 189 patients suffering from shoulder pain for at least three months despite receiving steroid injections and physiotherapy. Patients were randomized to receive one of three treatment options: subacromial decompression surgery, placebo surgery (diagnostic arthroscopy, which involved arthroscopic examination of the shoulder joint but no therapeutic procedures) or supervised exercise therapy. The patients were followed up with two years after treatment.
"With nearly 21,000 decompression surgeries done in the U.K. every year, and ten times that many in the U.S., the impact of this study is huge," said Simo Taimela, MD, PhD, research director of the Finnish Centre for Evidence-Based Orthopedics at the University of Helsinki in Finland .
Here are some key findings:
1. Shoulder pain was decreased in all three groups, but decompression surgery offered no greater benefit than placebo surgery.
2. The exercise therapy group improved over time as well, with the decompression surgery group improving slightly more. However, the researchers said the difference in improvement between decompression surgery and exercise therapy to be clinically significant.
3. "These results show this type of surgery is not an effective form of treatment for this most common shoulder complaint.,” said researcher Mika Paavola, MD, PhD. “With results as crystal clear as this, we expect this will lead to major changes in contemporary treatment practices.”
4. "Based on these results, 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 nonoperative means,” said Teppo Järvinen, MD, PhD, one of the study's principal investigators.