Shoulder pain: far too much surgery and not enough evidence

In most shoulder pain, surgery would only have a placebo effect according to the most recent studies. This is emphasized by a panel of experts who recommends reducing the indications.

Surgery should not be performed in the majority of patients with conflict shoulder pain, otherwise known as "painful shoulder" or "subacromial conflict" (rotator cuff disease). This is affirmed by a panel of international experts in the BMJ.

This recommendation against surgery is based on a set of new studies demonstrating that acromioplasty surgery does not sufficiently improve pain, mobility or quality of life, compared to other treatment options.

A change in practices

According to these experts, this new recommendation, based on solid facts, should change practices, given the risk of complication for patients and the waste of health care resources for society.
These recommendations are part of the "BMJ Rapid Recommendations" initiative to produce fast and reliable recommendations based on the most recent and successful studies. All this to help doctors make better decisions with their patients.

Subacromial conflict

Subacromial conflict shoulder pain refers to non-traumatic shoulder pain associated with weakness or limitation of movement, particularly during arm elevation and abduction.
This type of pain is common in people over 40 years and decompression surgery ("acromioplasty") is a frequently proposed surgery if the pain and other problems do not disappear after conventional medical treatment (analgesic, NSAID or infiltration). + rehabilitation in decoaptation of the shoulder). In 2010, 21,000 such interventions were performed at NHS hospitals (public hospitals in the UK) at a cost of around £ 50 million.
However, several recent trials have shown that decompression surgery has no advantage over placebo or other treatments such as analgesics, rehabilitation and corticosteroid injections, combined with rehabilitation.

Multidisciplinary recommendations

The international panel convened by the BMJ was composed of orthopedic surgeons, rehabilitators, clinical physicians experienced in the treatment of shoulder pain, as well as patients suffering from this condition. They conducted a detailed analysis of the latest available data and developed recommendations in accordance with the standards for good design practice, incorporating the GRADE approach (system used to assess the quality of evidence).
This strong recommendation against surgery is based on two systematic reviews of evidence, one based on the pros and cons of decompression surgery and the other on significant improvements in pain, upper limb mobility, and quality of life according to the patients.

Too much surgery and too much spending

The panel of experts is thus convinced that acromioplasty-type surgery provides no significant benefit in terms of pain, function, quality of life or perceived improvement in the majority of these patients. Surgery is expensive and potentially dangerous.

"Doctors should not offer patients sub-acromial decompression surgery without specific justification," according to panel experts. However, the same experts point out that there is a great variability in alternative care and that this one deserves to be better defined.

Video: Is Your Shoulder Pain a Rotator Cuff Tear? How to Tell & What to Do If It Is. (February 2020).