Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis

Lähdeoja, Tuomas; Karjalainen, Teemu; Jokihaara, Jarkko; Salamh, Paul A.; Kavaja, Lauri; Agarwal, Arnav; Winters, Marinus; Buchbinder, Rachelle; Guyatt, Gordon; Vandvik, Per Olav; Ardern, Clare L

doi:10.1136/bjsports-2018-100486

Cited by 77 publications

(77 citation statements)

References 51 publications

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“…Parallel teams conducted these systematic reviews 1415. Another team updated a Cochrane systematic review synchronised with this BMJ Rapid Recommendation 16.…”

Section: Current Practicementioning

confidence: 99%

“…This BMJ Rapid Recommendation is in response to two recent trials1213 which found that subacromial decompression surgery provided no benefit over placebo surgery. The recommendation is based on two linked systematic reviews on benefits and harms of subacromial decompression surgery and minimally important differences in patient reported outcome measures for shoulder pain, function and quality of life 1415. The main infographic provides an overview of the relative and absolute benefits and harms of surgery in standard GRADE format.…”

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confidence: 99%

“…Lähdeoja T, Karjalainen T, Jokihaara J, et al Subacromial decompression surgery versus conservative management in patients with shoulder pain: a systematic review with meta-analysis. Br J Sports Med 2019; doi:10.1136/bjsports-2018-10048615…”

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confidence: 99%

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Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline

Vandvik

Lähdeoja

Ardern

et al. 2019

BMJ

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Clinical questionDo adults with atraumatic shoulder pain for more than 3 months diagnosed as subacromial pain syndrome (SAPS), also labelled as rotator cuff disease, benefit from subacromial decompression surgery? This guideline builds on to two recent high quality trials of shoulder surgery.Current practiceSAPS is the common diagnosis for shoulder pain with several first line treatment options, including analgesia, exercises, and injections. Surgeons frequently perform arthroscopic subacromial decompression for prolonged symptoms, with guidelines providing conflicting recommendations.RecommendationThe guideline panel makes a strong recommendation against surgery.How this guideline was createdA guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines and the GRADE system. The recommendation is based on two linked systematic reviews on (a) the benefits and harms of subacromial decompression surgery and (b) the minimally important differences for patient reported outcome measures. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of surgery in multilayered evidence summaries and decision aids available in MAGIC (www.magicapp.org) to support shared decisions and adaptation.The evidenceSurgery did not provide important improvements in pain, function, or quality of life compared with placebo surgery or other options. Frozen shoulder may be more common with surgery.Understanding the recommendationThe panel concluded that almost all informed patients would choose to avoid surgery because there is no benefit but there are harms and it is burdensome. Subacromial decompression surgery should not be offered to patients with SAPS. However, there is substantial uncertainty in what alternative treatment is best.

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“…Parallel teams conducted these systematic reviews 1415. Another team updated a Cochrane systematic review synchronised with this BMJ Rapid Recommendation 16.…”

Section: Current Practicementioning

confidence: 99%

mentioning

confidence: 99%

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Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline

Vandvik

Lähdeoja

Ardern

et al. 2019

BMJ

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“…Subacromial decompression with repair of teared tendons has been a very popular method to treat RCT for a long period of time, and the number of surgeries with subacromial decompression has increased signi cantly in the last two decades in America and the United Kingdom 3,4 . In most cases, the procedures of subacromial decompression consist of debridement of bursa, resection of anterior acromion and release of coracoacromial ligament without involvement of humeral head 5,6,7,8 . However, any impingement related with RCT is formed by both acromion and the GT of humerus, which means the GT is of equal important in the progression of subacromial impingement.…”

Section: Introductionmentioning

confidence: 99%

The greater tuberosity radius ratio: maybe a new predictor in diagnosis of rotator cuff tear

Sun

Liu

et al. 2020

Preprint

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Background The role of the greater tuberosity of humerus in subacromial impingement should be of equal important as the acromion. In this study we concerned on the morphological characteristics of the greater tuberosity of humerus and proposed the greater tuberosity radius ratio (GTRR) as a new predictor for the diagnosis of rotator cuff tear. We hypothesized that a larger value of the GTRR could increase the risk of developing rotator cuff tear. Methods This was a retrospective study and clinical data and preoperative computed tomography images of the patients with rotator cuff tears (defined as the RCT group, simple size: 61) or without rotator cuff tears (defined as the control group, simple size: 56) were collected. Three-dimensional models of shoulders were established by multiplanar reconstruction of computed tomography scans. In a standard anteroposterior view, the radius of the best-fit circle of the humeral head (the r) and the radius of the concentric circle passing through the most superolateral edge of the greater tuberosity (the R) were measured for each shoulder. The ratio of R and r (R/r) was defined as the greater tuberosity radius ratio (GTRR). Independent samples t tests were used to find significant differences within the r, the R and the GTRR between groups. Receiver operating characteristic (ROC) curve based on the values of GTRR was performed to determine an applied cutoff value which may be useful in clinical practice. Results There was no significant difference in the values of r or R. However, the mean values of GTRR were 1.339 ± 0.143 (range, 1.087–1.684) and 1.244 ± 0.172 (range, 1.040–1.706) in the two groups respectively (p = 0.002). According to the ROC curve, an optimized cutoff value of GTRR was determined as 1.262, whose sensitivity was 72% and specificity was 65% for diagnosis of rotator cuff tear. Conclusion The greater tuberosity of humerus contributes to the mechanisms of rotator cuff tear. The greater tuberosity radius ratio is recommended as a new predictor for diagnosis of rotator cuff tear, with an optimized cutoff value set as 1.262.

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“…Styrken på anbefalingene er gradert etter kvaliteten på foreliggende kunnskapsgrunnlag/evidens vurdert med GRADE (Grading of Recommendations Assessment) (13,14), arbeidsgruppens råd og høringsuttalelser (ramme 2). I en artikkel i British Medical Journal fra 2019 basert på nye systematiske oversikter (15,16) anbefales ikke kirurgi ved subakromiale smerter (17). Vår veileder er publisert på Helsebiblioteket.no og gir konkrete anbefalinger ved subakromiale smerter og andre skulderdiagnoser (18).…”

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Atraumatiske skuldersmerter i primærhelsetjenesten

Juel¹,

Pedersen²,

Engebretsen³

et al. 2019

Tidsskriftet

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Niels Gunnar Juel er spesialist i fysikalsk medisin og rehabilitering og overlege ved Oslo universitetssykehus. Han er dr.philos., laerebokforfatter og lektor ved Avdeling for allmennmedisin, Universitetet i Oslo. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. STEIN JARLE PEDERSEN Stein Jarle Pedersen er spesialist i allmennmedisin, stipendiat ved Institutt for helse og samfunn, Universitetet i Oslo, og fastlege ved Ankerløkka Legesenter i Fredrikstad. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. KAIA BECK ENGEBRETSEN Kaia Beck Engebretsen er ph.d., spesialfysioterapeut og klinisk spesialist ved Oslo universitetssykehus. Hun forsker på og arbeider med skulderplager. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. KJETIL GUNDRO BRURBERG Kjetil Gundro Brurberg er ph.d. og seniorforsker ved Folkehelseinstituttet. Han er metodeekspert innen systematiske oversikter og retningslinjer. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. OLE MARIUS EKEBERG Ole Marius Ekeberg er ph.d., spesialist i fysikalsk medisin og rehabilitering og overlege ved seksjon Fysikalsk medisin og rehabilitering, Helse Fonna. Han forsker på skulderplager. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. SILJE ENDRESEN REME Silje Endresen Reme er psykologspesialist ved Avdeling for smertebehandling, Oslo universitetssykehus, og professor ved Psykologisk Institutt, Universitetet i Oslo. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. JENS IVAR BROX Jens Ivar Brox er spesialist i fysikalsk medisin og rehabilitering, professor ved Universitetet i Oslo og leder av Nakke-og ryggpoliklinikken, Oslo universitetssykehus. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. BÅRD NATVIG Bård Natvig er professor ved Avdeling for allmennmedisin, Universitetet i Oslo. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. 18. Helsebiblioteket. Retningslinje for skulderplager i primaerhelsetjenesten. https://www.helsebiblioteket.no/retningslinjer/skulderplager-i-primaerhelsetjenesten (22.3.2019).

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Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis

Abstract: Objective To determine the benefits and harms of subacromial decompression surgery in adult patients with subacromial pain syndrome lasting for more than 3 months. Design Systematic review with meta-analysis. Main outcome measures Pain, physical function and health-related quality of life.

Cited by 77 publications

References 51 publications

Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline

Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline

The greater tuberosity radius ratio: maybe a new predictor in diagnosis of rotator cuff tear

Atraumatiske skuldersmerter i primærhelsetjenesten

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