Subacromial decompression surgery for rotator cuff disease

Karjalainen, Teemu; Jain, Nitin B.; Page, Cristina M; Lähdeoja, Tuomas; Johnston, Renea V; Salamh, Paul A.; Kavaja, Lauri; Ardern, Clare L; Agarwal, Arnav; Vandvik, Per Olav; Buchbinder, Rachelle

doi:10.1002/14651858.cd005619.pub3

Cited by 85 publications

(105 citation statements)

References 91 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. The panel asked the review team to explore potential subgroup effects for risk of bias in trials and different types of comparisons to surgery, such as exercise therapy.…”

Section: Current Practicementioning

confidence: 99%

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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Section: Current Practicementioning

confidence: 99%

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

Vandvik

Lähdeoja

Ardern

et al. 2019

BMJ

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“…10 Nevertheless, a recent Cochrane review concluded that "some people will derive substantial benefit with pregabalin; more will have moderate benefit, but many will have no benefit or will discontinue treatment". 11 In approximately 60% of cases, PNP is localized, affecting a specific and limited area of the body. 3 In the case of localized PNP, it is prudent to consider a local treatment such as a lidocaine 5% patch or capsaicin.…”

Section: Introductionmentioning

confidence: 99%

<p>Expert Opinion: Exploring the Effectiveness and Tolerability of Capsaicin 179 mg Cutaneous Patch and Pregabalin in the Treatment of Peripheral Neuropathic Pain</p>

Huygen¹,

Kern²,

Pérez

2020

JPR

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Background and Objective: Treatment of peripheral neuropathic pain (PNP) remains a challenge. In the absence of clear predictors of response, clinical decision-making involves trial and error. While many classes of pharmacological agent are used and have shown efficacy, one of the most commonly used first-line treatments is pregabalin. However, in the 60% of PNP cases in which the pain is localized, a local treatment may be more suitable. This article will summarize the evidence for the relative effectiveness and tolerability of the capsaicin 179 mg patch and pregabalin in the treatment of PNP and highlight the expert opinion of the authors based on their own clinical experiences. Results: When compared in a head-to-head trial in patients with PNP, capsaicin 179 mg patch provided non-inferior pain relief compared with an optimized dose of pregabalin, as well as a reduction in dynamic mechanical allodynia, faster onset of action, fewer systemic side effects, and greater treatment satisfaction. Adverse events associated with capsaicin patch are mainly application site reactions, compared with systemic and central nervous system effects with pregabalin. Studies indicate that capsaicin 179 mg patch is associated with a lower burden of therapy than pregabalin in terms of improved tolerability, lack of a daily pill burden, lack of drug-drug interactions, and increased regimen flexibility. Conclusion: In localized neuropathic pain, evidence supports a pragmatic approach of using a local treatment before considering a systemic treatment. For treatment selection, the patient profile (eg, concomitant medication use, age) and the treatments' efficacy and tolerability profiles should be considered.

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“…Moreover, RCTs focused on shoulder pain with intact rotator cuff tendons were excluded [188]. High-certainty evidence shows that subacromial decompression does not provide clinically important benefits over placebo in pain, function, or health-related quality of life [189].…”

Section: Discussionmentioning

confidence: 99%

A Historical Analysis of Randomized Controlled Trials in Rotator Cuff Tears

Candela

Longo

Naro

et al. 2020

IJERPH

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Background and objectives: Our research aimed to evaluate the quality of reporting of randomized controlled trials (RCTs) linked to rotator cuff (RC) tears. The present study analyzed factors connected to the quality of the RCTs and trends in the quality of reporting through time. Materials and Methods: The online databases used to search all RCTs on the topic of RC surgery completed until March 2020 were PubMed and Ovid (MEDLINE). The quality of reporting was evaluated using the modified Coleman methodology score (MCMS) and the consolidated standards of reporting trials (CONSORT). Results: The online search found 957 articles. Finally, 183 studies were included in the quantitative synthesis. A total of 97 (53%) of 183 studies had a level of evidence I and 86 (47%) of 183 studies had a level of evidence II, according to the Oxford Center of Evidence Based Medicine (EBM). A statistically significant difference in MCMS between articles written before 2010 and articles written after 2010 was found. Articles written after 2010 had, on average, the highest Coleman score. The average number of CONSORT checklist items for each article across all analyzed RCTs was 21.67. The 37 studies completed up to 2010 averaged a number of checklist items of 19.97 and the studies completed between 2011 and 2019 averaged a number of checklist items of 22.10. A statistically significant difference in the number of checklist items between articles written before 2010 and articles written after 2010 was found. Articles written after 2010 had on average more checklist items. However, low correlation (0.26) between the number of checklist items for each article and the respective Coleman score was found. On the other hand, articles with the CONSORT diagram had a significantly high Coleman score. Conclusions: An improvement in the quantity and quality of RCTs relating to RC surgery over the analyzed period was found.

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Subacromial decompression surgery for rotator cuff disease

Cited by 85 publications

References 91 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

<p>Expert Opinion: Exploring the Effectiveness and Tolerability of Capsaicin 179 mg Cutaneous Patch and Pregabalin in the Treatment of Peripheral Neuropathic Pain</p>

A Historical Analysis of Randomized Controlled Trials in Rotator Cuff Tears

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