Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial

Abstract

ObjectivesTo assess the long-term efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy (primary comparison), a placebo surgical intervention, and with a non-operative alternative, exercise therapy (secondary comparison).MethodsWe conducted a multicentre, three group, randomised, controlled superiority trial. We included 210 patients aged 35–65 years, who had symptoms consistent with shoulder impingement syndrome for more than 3 months. 175 participants (83%) completed the 5 years follow-up. Patient enrolment began on 1 February 2005 and the 5-year follow-up was completed by 10 October 2018. The two primary outcomes were shoulder pain at rest and on arm activity measured with Visual Analogue Scale (VAS). Minimally important difference (MID) was set at 15. We used a mixed-model repeated measurements analysis of variance with participant as a random factor, the baseline value as a covariate and assuming a covariance structure with compound symmetry.ResultsIn the primary intention to treat analysis (ASD vs diagnostic arthroscopy), there were no between-group differences that exceeded the MID for the primary outcomes at 5 years: the mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were −2.0 (95% CI −8.5 to 4.6; p=0.56) at rest and −8.0 (−17.3 to 1.3; p=0.093) on arm activity. There were no between-group differences in the secondary outcomes or adverse events that exceeded the MID. In our secondary comparison (ASD vs exercise therapy), the mean differences between groups (ASD minus exercise therapy) in pain VAS were 1.0 (−5.6 to 7.6; p=0.77) at rest and −3.9 (−12.8 to 5.1; p=0.40) on arm activity. There were no significant between-group differences for the secondary outcomes or adverse events.ConclusionsASD provided no benefit over diagnostic arthroscopy (or exercise therapy) at 5 years for patients with shoulder impingement syndrome.

Proper Indications for Shoulder Subacromial Decompression Result in Excellent Outcomes

“…The recent debate 13,14 in the journal Arthroscopy: The Journal of Arthroscopic & Related Surgery about the utility of subacromial decompression reflects the problem: on one side, an evidence-based approach based on trials suffering from poor methodology (i.e., diverse or vague indications such as "subacromial pain for at least 3 months") [15][16][17][18][19][20][21][22] and, on the other side, a clinical and rational approach of surgeons knowing that parsimonious indications after conservative treatment failure lead to great results. 23 As usual in life, the truth probably lies in between.…”

Structural and Functional Asymmetry in Precentral and Postcentral Gyrus in Patients With Unilateral Chronic Shoulder Pain

“…We collected MRI data from all participants. Before MRI scanning, VAS score (20)(21)(22) and Constant-Murley score (CMS) (23) were evaluated by participants. VAS (range 0-100 mm, 0 = no pain, 100 = worst pain) is a commonly used scale to evaluate the intensity of pain.…”

A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment

“…Extracorporeal shockwave therapy and barbotage have shown to be beneficial for calcific tendinitis [113]. In cases of refractory symptoms, referral for surgery can be considered however surgical decompression (which is the intervention performed most often) has been shown to have little to no benefit for long-term pain [113,119,120].…”