In the JournalsPerspectiveFrom OT Europe

Better, but not clinically important, results with surgery vs no treatment for subacromial shoulder pain

Results from this study indicated arthroscopic subacromial decompression and arthroscopy only both yielded better outcomes for shoulder pain and function among patients who had subacromial pain and intact rotator cuff tendons vs. no treatment. However, the differences between the three groups were not clinically important.

“We have found out several things from this placebo-controlled surgical trial,” David J. Beard, MB, ChB, FRCS, told Healio.com/Orthopedics. “Subacromial decompression surgery does not appear to work in the way we thought it did, and the surgery is not as nearly as effective as we might have hoped for in this population of patients. The results will likely produce a change (reduction) in practice, but it would be wrong to dismiss or decommission this procedure entirely. We now have to look in greater detail which specific patients might still potentially benefit from this type of surgery.”

Beard and colleagues performed a multicenter, randomized, pragmatic, parallel group, placebo-controlled, three-group trial of 313 patients who had subacromial shoulder pain for at least 3 months and intact rotator cuff tendons. There were 106 patients randomly assigned to undergo arthroscopic subacromial decompression surgery, 103 patients who underwent arthroscopy only and 104 patients who received no treatment. After patients were randomized, follow-up visits occurred at 6 months and 1 year. Outcomes assessed included the Oxford shoulder score, modified Constant-Murley shoulder score, PainDetect, quantitative sensory testing, EuroQol 5-D three-level index, quality of life, treatment expectations, patients’ perception or satisfaction and anxiety and depression scores.

Results showed at that 6 months, 24 decompression patients, 43 arthroscopy-only patients and 12 no-treatment patients did not receive the treatment initially assigned to them. Investigators noted that at 6 months, there were no differences in mean Oxford shoulder scores between patients who underwent decompression and those who underwent arthroscopy only. Compared to patients assigned to no treatment, patients assigned to either surgical treatment group saw a small benefit from their procedure; however, the differences were not clinically important. In total, there were six frozen shoulders. Two frozen shoulders occurred in each group. – by Monica Jaramillo

 

Disclosures: Researchers report no relevant financial disclosures.

Results from this study indicated arthroscopic subacromial decompression and arthroscopy only both yielded better outcomes for shoulder pain and function among patients who had subacromial pain and intact rotator cuff tendons vs. no treatment. However, the differences between the three groups were not clinically important.

“We have found out several things from this placebo-controlled surgical trial,” David J. Beard, MB, ChB, FRCS, told Healio.com/Orthopedics. “Subacromial decompression surgery does not appear to work in the way we thought it did, and the surgery is not as nearly as effective as we might have hoped for in this population of patients. The results will likely produce a change (reduction) in practice, but it would be wrong to dismiss or decommission this procedure entirely. We now have to look in greater detail which specific patients might still potentially benefit from this type of surgery.”

Beard and colleagues performed a multicenter, randomized, pragmatic, parallel group, placebo-controlled, three-group trial of 313 patients who had subacromial shoulder pain for at least 3 months and intact rotator cuff tendons. There were 106 patients randomly assigned to undergo arthroscopic subacromial decompression surgery, 103 patients who underwent arthroscopy only and 104 patients who received no treatment. After patients were randomized, follow-up visits occurred at 6 months and 1 year. Outcomes assessed included the Oxford shoulder score, modified Constant-Murley shoulder score, PainDetect, quantitative sensory testing, EuroQol 5-D three-level index, quality of life, treatment expectations, patients’ perception or satisfaction and anxiety and depression scores.

Results showed at that 6 months, 24 decompression patients, 43 arthroscopy-only patients and 12 no-treatment patients did not receive the treatment initially assigned to them. Investigators noted that at 6 months, there were no differences in mean Oxford shoulder scores between patients who underwent decompression and those who underwent arthroscopy only. Compared to patients assigned to no treatment, patients assigned to either surgical treatment group saw a small benefit from their procedure; however, the differences were not clinically important. In total, there were six frozen shoulders. Two frozen shoulders occurred in each group. – by Monica Jaramillo

 

Disclosures: Researchers report no relevant financial disclosures.

    Perspective
    Carlos Torrens

    Carlos Torrens

    The Can Shoulder Arthroscopy Work? study group did a courageous effort to increase the body of evidence on subacromial shoulder pain treatment. Moreover, they included a placebo-controlled comparison. Since the advent of arthroscopic subacromial decompression, surgery for subacromial shoulder pain has dramatically increased in all countries. Despite a relatively large number of clinical trials on the topic, including a study by Ketola and her colleagues on arthroscopic decompression not being recommended to treat rotator cuff tendinopathy, which had a minimum of 10 years follow-up, the trend towards increased arthroscopic indications is still a concern. Hopefully, this study may give a definitive look into the lack of utility of arthroscopic subacromial decompression in this common condition of subacromial shoulder pain.

    Reference:

    Ketola S, et al. Bone Joint J. 2017;doi:10.1302/0301-620X.99B6.BJJ-2016-0569.R1. 

    • Carlos Torrens , MD, PhD
    • Chairman of shoulder unit Hospital del Mar Barcelona

    Disclosures: Torrens reports no relevant financial disclosures.