Doubts over common shoulder op
21st November 2017 – The value of a common operation designed to reduce shoulder pain is in doubt.
Researchers from the University of Oxford, and University of Bristol, found decompression surgery for people with shoulder impingement may offer no benefit.
In the UK shoulder pain accounts for 2.4% of all visits to the GP and can make it difficult to work, drive, or get dressed.
When over-the-counter pain relief, physiotherapy, and steroids, have failed to bring relief from shoulder pain, patients are sometimes offered decompression keyhole surgery. It is one of the most commonly used operations in orthopaedics and tens of thousands of people undergo it each year.
Decompression surgery involves removing a small area of bone and soft tissue to open up the joint and prevent rubbing or catching when the arm is lifted, so relieving pain.
First ever trial
The first ever placebo-controlled trial in shoulder surgery involved 32 hospitals and 51 surgeons across the UK.
In the study people who had shoulder pain for at least 3 months despite having physiotherapy and steroid injections were divided into 3 groups.
- 90 people had decompression keyhole surgery and tissue was removed
- 94 people had placebo keyhole surgery when surgeons inspected the joint but removed no tissue
- 90 people had no treatment
Surgery patients were unaware which surgery they had undergone and had to have physiotherapy sessions afterwards. Patients having no treatment only had a check-up appointment 3 months after the start of the trial.
Six and 12 months after they entered the trial, the participants completed questionnaires rating their symptoms, including pain.
Overall, symptoms reduced in all 3 groups.
At 6 months, people who had decompression surgery and those who had placebo surgery rated their pain and function at a similar level and both forms of surgery showed a small but not significant benefit over no treatment.
However, the authors of the study say the difference is unlikely to result in a noticeable variation in symptoms.
The findings have been published in The Lancet.
There were some limitations to the study but, despite these, the researchers believe their findings question the value of the operation, and they say patients considering decompression surgery should be informed.
Commenting on the findings in a linked article, Dr Berend Schreurs, Radboud University Medical Center, the Netherlands, says: "The findings send a strong message that the burden of proof now rests on those who wish to defend the standpoint that shoulder arthroscopy is more effective than non-surgical interventions. Hopefully, these findings from a well-respected shoulder research group will change daily practice."
Natalie Carter, head of research liaison and evaluation at Arthritis Research UK, which helped fund the study, says in an emailed statement: "Many people with shoulder pain are treated with, and will respond to, non-operative treatment alone, however surgery is often used as a treatment. In 2010, over 21,000 people had this type of surgery in England – an increase of nearly 750% in 10 years.
"This study suggests that other treatments such as physiotherapy can be just as effective as shoulder surgery, and should be taken into consideration with patients considering surgery and could influence the decisions made by health providers.
"Often shoulder pain can be short-lived, but if you’re experiencing shoulder pain which continues for more than 2 weeks, or gets worse, speak to your doctor or a physiotherapist in case you have a more complex problem."