Subacromial decompression surgery for shoulder pain

BMJ ◽  
2019 ◽  
pp. l586
Author(s):  
Nick A Aresti ◽  
Livio Di Mascio
Keyword(s):  
Shoulder Pain ◽  
Decompression Surgery ◽  
Subacromial Decompression

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

BMJ ◽  
2019 ◽  
pp. l294 ◽  
Author(s):  
Per Olav Vandvik ◽  
Tuomas Lähdeoja ◽  
Clare Ardern ◽  
Rachelle Buchbinder ◽  
Jaydeep Moro ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Decision Aids ◽  
Treatment Options ◽  
Frozen Shoulder ◽  
Pain Syndrome ◽  
Decompression Surgery ◽  
Subacromial Decompression ◽  
Guideline Panel ◽  
Common Diagnosis ◽  
Patient Reported

AbstractClinical 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.

scholarly journals Minimal important differences for improvement in shoulder condition patient-reported outcomes: a systematic review to inform aBMJRapid Recommendation

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e028777 ◽  
Author(s):  
Qiukui Hao ◽  
Tahira Devji ◽  
Dena Zeraatkar ◽  
Yuting Wang ◽  
Anila Qasim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Pain ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Decompression Surgery ◽  
Subacromial Decompression ◽  
Review Team ◽  
Patient Reported ◽  
Minimal Important Differences

ObjectivesTo identify credible anchor-based minimal important differences (MIDs) for patient-reported outcome measures (PROMs) relevant to aBMJRapid Recommendations addressing subacromial decompression surgery for shoulder pain.DesignSystematic review.Outcome measuresEstimates of anchor-based MIDs, and their credibility, for PROMs judged by the parallelBMJRapid Recommendations panel as important for informing their recommendation (pain, function and health-related quality of life (HRQoL)).Data sourcesMEDLINE, EMBASE and PsycINFO up to August 2018.Study selection and review methodsWe included original studies of any intervention for shoulder conditions reporting estimates of anchor-based MIDs for relevant PROMs. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria. Six reviewers, working in pairs, independently extracted data from eligible studies using a predesigned, standardised, pilot-tested extraction form and independently assessed the credibility of included studies using an MID credibility tool.ResultsWe identified 22 studies involving 5562 patients that reported 74 empirically estimated anchor-based MIDs for 10 candidate instruments to assess shoulder pain, function and HRQoL. We identified MIDs of high credibility for pain and function outcomes and of low credibility for HRQoL. We offered median estimates for the systematic review team who applied these MIDs in Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence summaries and in their interpretations of results in the linked systematic review addressing the effectiveness of surgery for shoulder pain.ConclusionsOur review provides anchor-based MID estimates, as well as a rating of their credibility, for PROMs for patients with shoulder conditions. The MID estimates inform the interpretation for a linked systematic review and guideline addressing subacromial decompression surgery for shoulder pain, and could also prove useful for authors addressing other interventions for shoulder problems.PROSPERO registration numberCRD42018106531.

scholarly journals Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial

2016 ◽  
Vol 96 (6) ◽  
pp. 787-796 ◽  
Author(s):  
David Høyrup Christiansen ◽  
Poul Frost ◽  
Deborah Falla ◽  
Jens Peder Haahr ◽  
Lars Henrik Frich ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Outcome Measures ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Exercise Group ◽  
Subacromial Impingement Syndrome ◽  
Decompression Surgery ◽  
Subacromial Decompression ◽  
Randomized Controlled

Background Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. Objective The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. Design A multicenter randomized controlled trial was conducted. Setting The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. Patients One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. Intervention A standardized exercise program consisting of physical therapist–supervised individual training sessions and home training was used. Outcome Measures The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. Results At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=−0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. Limitations The nature of the exercise intervention did not allow blinding of patients and care providers. Conclusion The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and function at 12 months compared with usual care.

scholarly journals Does arthroscopic subacromial decompression improve quality of life

2015 ◽  
Vol 97 (3) ◽  
pp. 221-223 ◽  
Author(s):  
U Butt ◽  
A Whiteman ◽  
J Wilson ◽  
E Paul ◽  
B Roy
Keyword(s):  
Quality Of Life ◽  
Cost Effective ◽  
Decompression Surgery ◽  
Subacromial Decompression ◽  
Oxford Shoulder Score ◽  
Effective Manner ◽  
The Mean ◽  
Arthroscopic Subacromial Decompression ◽  
Shoulder Score

Introduction There has been a significant rise in the volume of subacromial decompression surgery performed in the UK. This study aimed to determine whether arthroscopic subacromial decompression improves health related quality of life in a cost effective manner. Methods Patients undergoing arthroscopic subacromial decompression surgery for impingement were enrolled between 2012 and 2014. The Oxford shoulder score and the EQ-5D™ instruments were completed prior to and following surgery. A cost–utility analysis was performed. Results Eighty-three patients were eligible for the study with a mean follow-up duration of 15 months (range: 4–27 months). The mean Oxford shoulder score improved by 13 points (95% confidence interval [CI]: 11–15 points). The mean health utility gain extrapolated from the EQ-5D™ questionnaire improved by 0.23 (95% CI: 0.16–0.30), translating to a minimum cost per QALY of £5,683. Conclusions Subacromial decompression leads to significant improvement in function and quality of life in a cost effective manner. This provides justification for its ongoing practice by appropriately trained shoulder surgeons in correctly selected patients.

scholarly journals Subacromial decompression surgery for rotator cuff disease

2019 ◽  
Author(s):  
Teemu V Karjalainen ◽  
Nitin B Jain ◽  
Cristina M Page ◽  
Tuomas A Lähdeoja ◽  
Renea V Johnston ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Decompression Surgery ◽  
Rotator Cuff Disease ◽  
Subacromial Decompression

scholarly journals Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: an international mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e054032
Author(s):  
Joshua Zadro ◽  
Caitlin Jones ◽  
Ian Harris ◽  
Rachelle Buchbinder ◽  
Denise A O'Connor ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Health Professionals ◽  
Decision Aid ◽  
Pain Syndrome ◽  
Decompression Surgery ◽  
Patient Decision Aid ◽  
Subacromial Pain Syndrome ◽  
Patient Decision ◽  
Informed Treatment ◽  
Cuff Repair

ObjectiveTo develop and user test a patient decision aid for people with subacromial pain syndrome that presents evidence-based information on the benefits and harms of subacromial decompression surgery and rotator cuff repair surgery.DesignMixed-methods study outlining the development of a patient decision aid.SettingWe assembled a multidisciplinary steering group, and used existing decision aids and decision science to draft the decision aid. Participants were recruited through social media (not restricted by country nor setting), local hospitals and the authors’ collaboration network.ParticipantsPeople with shoulder pain and health professionals who manage people with shoulder pain.Primary and secondary outcomesWe interviewed participants to gather feedback on the decision aid, assessed useability and acceptability (using qualitative and quantitative methods) and performed iterative cycles of redrafting the decision aid and reinterviewing participants as necessary. Interview data were analysed using thematic analysis. Quantitative data were summarised descriptively.ResultsWe interviewed 26 health professionals (11 physiotherapists, 7 orthopaedic surgeons, 4 general practitioners, 3 chiropractors and 1 osteopath) and 14 people with shoulder pain. Most health professionals and people with shoulder pain rated all aspects of decision aid acceptability as adequate-to-excellent (eg, length, presentation, comprehensibility). Interviews highlighted agreement among health professionals and people with shoulder pain on most aspects of the decision aid (eg, treatment options, summary of benefits, harms and practical issues, questions to ask a health professional, graphics, formatting). However, some aspects of the decision aid elicited divergent views among health professionals (eg, causes and symptoms of shoulder pain, evidence on benefits and harms).ConclusionThis decision aid could be an acceptable and valuable tool for helping people with subacromial pain syndrome make informed treatment choices. A randomised controlled trial evaluating whether this decision aid reduces people’s intentions to undergo shoulder surgery and facilitates informed treatment choices is underway.Trial registration number ACTRN12621000992808

scholarly journals Longitudinal study of use and cost of subacromial decompression surgery: the need for effective evaluation of surgical procedures to prevent overtreatment and wasted resources

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030229 ◽  
Author(s):  
Tim Jones ◽  
Andrew J Carr ◽  
David Beard ◽  
Myles-Jay Linton ◽  
Leila Rooshenas ◽  
...  
Keyword(s):  
New York ◽  
Health Systems ◽  
Surgical Procedures ◽  
Western Australia ◽  
New York State ◽  
Good Evidence ◽  
Decompression Surgery ◽  
Subacromial Decompression ◽  
York State ◽  
Effective Evaluation

ObjectivesTo illustrate the need for better evaluation of surgical procedures, we investigated the use and cost of subacromial decompression in England over the last decade compared with other countries and explored how this related to the conduct and outcomes of randomised, placebo-controlled clinical trials.DesignLongitudinal observational study using Hospital Episode Statistics linked to Payment by Results tariffs in England, 2007/2008 to 2016/2017.SettingHospital care in England; Finland; New York State, USA; Florida State, USA and Western Australia.ParticipantsPatients with subacromial shoulder pain.InterventionsSubacromial decompression.Main outcome measuresNational procedure rates, costs and variation between clinical commissioning groups in England.ResultsWithout robust clinical evidence, the use of subacromial decompression in England increased by 91% from 15 112 procedures (30 per 100 000 population) in 2007/2008, to 28 802 procedures (52 per 100 000 population) in 2016/2017, costing over £125 million per year. Rates of use of subacromial decompression are even higher internationally: Finland (131 per 100 000 in 2011), Florida State (130 per 100 000 in 2007), Western Australia (115 per 100 000 in 2013) and New York State (102 per 100 000 in 2006). Two randomised placebo-controlled trials have recently (2018) shown the procedure to be no more effective than placebo or conservative approaches. Health systems appear unable to avoid the rapid widespread use of procedures of unknown effectiveness, and methods for ceasing ineffective treatments are under-developed.ConclusionsWithout good evidence, nearly 30 000 subacromial decompression procedures have been commissioned each year in England, costing over £1 billion since 2007/2008. Even higher rates of procedures are carried out in countries with less regulated health systems. High quality randomised trials need to be initiated before widespread adoption of promising operative procedures to avoid overtreatment and wasted resources, and methods to prevent or desist the use of ineffective procedures need to be expedited.

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