Arthroscopic subacromial decompression may not improve pain relative to placebo surgery or provide clinically important benefits compared with no treatment in patients with subacromial shoulder pain, according to a study published in The Lancet.

In this multicenter controlled trial, participants with subacromial shoulder pain for ≥3 months and intact rotator cuff tendons and who had completed a non-operative management program were enrolled.

Participants were randomly assigned to undergo arthroscopic subacromial decompression (n=90), investigational arthroscopy (placebo; n=94), or no treatment (n=90). The Oxford Shoulder Score was measured at 6 months.

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Mean Oxford Shoulder Score results were not different between surgical groups at 6 months post-randomization (32.7 points for decompression vs 34.2 points for placebo; P =.3141). Decompression surgery was associated with better mean Oxford Shoulder Score results compared with no treatment (mean difference, 2.8 points; P =.0186), as was placebo surgery (mean difference, 4.2 points; P =.0014). Neither surgical intervention met the pre-specified criterion for a minimum clinically important difference of 4.5 points. All study-related complications were frozen shoulders, with 2 occurring in each group.

The study authors concluded that, “although both types of surgery provide greater symptom improvement than no treatment, this difference was of uncertain clinical significance.

The findings (which should be communicated to patients during the shared treatment decision-making process) question the value of this type of surgery for these indications, and might discourage some surgeons from offering decompression surgery and dissuade some patients from undergoing the surgery.”

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Beard DJ, Rees JL, Cook JA, et al; CSAW Study Group. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial [published online November 20, 2017]. Lancet. doi:10.1016/S0140-6736(17)32457-1