For adults with atraumatic shoulder pain, it can be a difficult decision whether or not to have surgery. However, a new clinical practice guideline (CPG) published in British Medical Journal strongly advises against surgery in terms of effectiveness of surgery to resolve shoulder pain and potential complications.
Effectiveness of Surgery Versus Other Treatments for Shoulder Pain
Authors of the CPG researched adults with atraumatic shoulder pain (also known as subacromial pain syndrome, or SAPS) for 3 or more months, then compared the effectiveness of arthroscopic decompression surgery versus other nonsurgical approaches such as physical therapy and pain medication. After performing 7 trials involving 1,014 patients, the CPG group evaluated the patients’ experiences using two different criteria: a difference in pain of at least 1.5 points on a scale of 1-10 and a difference in function of at least 8.3 points on a 100 point scale. In both of these areas, decompression surgery showed no significant difference from other treatment options, including placebo surgery. The results remained the same even after 6 month, 2 years, and 5 years.
The authors of the CPG also evaluated 6 trials that compared surgery with physical therapy, and the results again showed no advantage of surgery in terms of pain, function, quality of life, perceived effect, and ability to return to work. Benefits and Risks of Surgery
Once the CPG group determined there is no advantage of surgery over other treatment options, they then looked at the benefits and risks of the surgery itself. They found a large U.S. study that concluded there is a 0.55% risk of complications resulting in readmission to the hospital 30 days after surgery. These complications can include major bleeding, deep infections, peripheral nerve injury, serious anesthetic complications, and venous thromboembolism. Another potential complication is frozen shoulder, or stiffness and pain in the shoulder joint. In this particular study, there were 12 or more frozen shoulders per 1,000 surgical patients.
Overall Recommendations
Because there seems to be no benefit to arthroscopic decompression surgery over other, non-surgical approaches, and there are complications associated with the surgery itself, the CPG panel “concluded that almost all well informed patients would decline surgery and therefore made a strong recommendation against subacromial decompression surgery.” They went on to say that physicians should not even offer their patients the surgery and should make an effort to educate the public on the ineffectiveness of the surgery.
As alternatives to surgery, the authors recommend physical therapy, manual therapy, and electrotherapies. These therapies seem to be safer and more effective than surgery for things like rotator cuff tears.
