Decompression Surgery May Not Improve Subacromial Shoulder Pain

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There might be little value in performing decompression surgery to treat subacromial shoulder pain.
There might be little value in performing decompression surgery to treat subacromial shoulder pain.

According to the results of a randomized controlled trial published in The Lancet, surgical intervention with arthroscopic subacromial decompression may not yield a clinically significant reduction in shoulder pain and function in patients with subacromial pain.

In this multicenter trial, participants with subacromial pain and intact rotator cuff tendons were enrolled to receive arthroscopic subacromial decompression (n=106), investigational arthroscopy with no bone or soft tissue removal (placebo; n=103), or no treatment (n=104). Pain and function were assessed at 6 and 12 months using the Oxford Shoulder Score.

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At 6 months, the percentage of patients who did not receive the treatment they were initially assigned was 23% for decompression surgery, 42% of arthroscopy only, and 12% for no treatment. According to the researchers, the high rate of nonadherence to treatment was the result of improvements while waiting for surgery, among other factors.

In an intention-to-treat analysis, the mean Oxford Shoulder Score (0-48 scale) did not differ significantly between the 2 surgical groups (P =.3). A statistically significant difference in the mean Oxford Shoulder Score was reported when the 2 surgical groups were compared with the no-treatment group (P =.02 for decompression; P =.001 for arthroscopy), but the differences were not considered clinically important.

Adverse events were not significantly different between groups. Frozen shoulders were the only reported study-related complications, with 2 occurrences reported in each group.

The researchers concluded that their results, “question the value of [decompression] surgery for [subacromial shoulder pain], 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. 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

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