Why common shoulder surgery does not reduce pain

London: A common surgery for shoulder impingement - when the tendon rubs and catches in the joint - does not reduce pain any more than a placebo surgery, according to a study published in The Lancet journal.

Although both types of surgery were slightly more effective at reducing subacromial shoulder pain compared to no treatment, the difference was small and not likely to result in a noticeable effect.

For subacromial shoulder pain, treatment options include subacromial decompression, which is one of the most commonly used surgeries in orthopaedics. The study questions the value of this operation, and that patients considering undergoing the operation should be
informed.

"Over the past three decades, patients with this form of shoulder pain and clinicians have accepted this surgery in the belief that it provides reliable relief of symptoms, and has low risk of adverse events and complications," said

Andrew Carr, Professor at the University of Oxford in the UK. "However, the findings from our study suggest that surgery might not provide a clinically significant benefit over no treatment, and that there is no benefit of decompression over placebo surgery," said Carr.

The study involved 32 hospitals and 51 surgeons across the UK. In the study, 90, 94 and 90 people who had suffered shoulder pain for at least three months despite having physiotherapy and steroid injections underwent decompression surgery, placebo surgery or no treatment, respectively.

They completed questionnaires about their level of pain and function at six months. Decompression surgery is a keyhole surgery that involves removing a small area of bone and soft tissue in the shoulder joint to open up the joint and prevent rubbing or catching when the arm is lifted.

In the placebo surgery, surgeons conducted a procedure to look inside the joint where the joint was inspected but no tissue was removed. Both surgeries were completed as keyhole procedures to ensure that patients were not aware of which surgery they had had.

Surgery participants also had one to four physiotherapy sessions afterwards, while those having no treatment only had a check-up appointment three 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 (from 0-48, with a higher number meaning less pain). Overall, symptoms diminished in all three groups from the start of the trial.

At six months, people who had decompression surgery and those who had placebo surgery rated their pain and function at a similar level, with no statistical difference (32.7 points and 34.2 points, respectively.