On Patient Safety: Shoulder “Impingement”—Telling a SAD Story About Public Trust

Abstract

From the Column Editor: The goal of the On Patient Safety column is to explore the relationship between patient safety and clinical efficacy. In this month's guest column, Teppo L. N. Järvinen MD, PhD, the head of the Finnish Center for Evidence-Based Orthopedics (FICEBO), gets to the heart of that relationship, as he describes the rise of a once-celebrated procedure and, despite the mounting evidence in front of us, our inability to fully accept its diminishing utility.Recognized around the world for producing cutting-edge research on common musculoskeletal problems, FICEBO envisions a world where only practices that are scientifically proven to be effective are offered to patients. We're not there yet, but Prof. Järvinen leads FICEBO's efforts and collaborates with researchers and physicians around the world to develop medical evidence and reduce the use of ineffective procedures.I found his analysis of the evidence surrounding the efficacy of subacromial decompression and his discussion on the importance of open, honest communication with patients with shoulder disease deeply important. I believe you will too.-James Rickert MD Like most orthopaedic surgeons, I have treated many patients for shoulder pain. After all, it's awfully common with around 4.5 million visits a year in the United States alone [19]. About 70% of patients with shoulder pain present with the classic "painful arch" while lifting the arm, which, for decades, had been considered a symptom caused by mechanical impingement of the rotator cuff complex between the humeral head and the undersurface of the acromion. This concept, and the original operation designed to treat it, subacromial decompression (SAD), just "celebrated" its 50 th anniversary [17].

Letter to the Editor: Editorial: Chance Encounters, Overdiagnosis, and Overtreatment

“…In your words: “My bad.” In two more words: Great job! And in an additional eighteen: Thanks for having the courage to write and bring the Finnish Centre for Evidence-Based Orthopaedics (FICEBO) [1] to my attention. (I’m embarrassed by my lack of awareness.…”

Editorial: Chance Encounters, Overdiagnosis, and Overtreatment

“…Our societies should not shy away from identifying ways we can improve. I hope that the next iteration of Choosing Wisely will do just that.Read this month’s guest “On Patient Safety” column [8] by Teppo Järvinen MD, PhD, the director of FICEBO. His group is doing some of the best work in the world on the problem of overdiagnosis and overtreatment, and his perspectives on the topic deserve our time and attention.If you’re a clinician-scientist with an interest in the topic of overdiagnosis and overtreatment, send your work to CORR.…”

“…3. Read this month's guest "On Patient Safety" column [8] by Teppo Järvinen MD, PhD, the director of FICEBO. His group is doing some of the best work in the world on the problem of overdiagnosis and overtreatment, and his perspectives on the topic deserve our time and attention.…”

Letter to the Editor: Editorial: Chance Encounters, Overdiagnosis, and Overtreatment

“…It is clear that surgery for subacromial impingement has decreased since Dr. Neer’s original insights on the technique [8], a direct result of research by Drs. Järvinen [6], Buchbinder [1], and others. They have serially shown in shoulder pain [6], lateral epicondylitis [5], and other conditions the utility of nonsurgical modalities including physical therapy to be equivalent to surgical treatment without the risks associated with discretionary surgery [7].…”

“…Järvinen [6], Buchbinder [1], and others. They have serially shown in shoulder pain [6], lateral epicondylitis [5], and other conditions the utility of nonsurgical modalities including physical therapy to be equivalent to surgical treatment without the risks associated with discretionary surgery [7]. But as I have argued in the case for lateral epicondylitis [3], it is important to identify the root cause of these conditions, and the root cause of shoulder impingement remains mostly a mystery.…”