Is a common shoulder surgery useless?

November 21, 2017

(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

A British research team tracked outcomes for who underwent " " to treat shoulder impingement—a condition where a shoulder tendon rubs and catches in the joint.

In decompression surgery, a small area of bone and soft tissue in the is removed, opening up the joint to prevent the abrasion that happens when the arm is lifted.

All of the patients had suffered for at least three months despite nonsurgical approaches, including physiotherapy and steroid injections.

So, the patients were then sent to decompression surgery (90 patients), a placebo surgery where they thought they got the procedure but didn't (94 patients), or no treatment (90 patients).

In the placebo surgery, the surgeons looked inside the joint but did not remove any tissue.

Both groups of surgery patients also had one to four physiotherapy sessions afterwards. Those in the no-treatment group had only a check-up three months after the start of the study.

Six to 12 months after entering the study, shoulder symptoms had eased in all three groups of patients, regardless of whether they got the surgery or not, noted a team led by Andrew Carr of the University of Oxford.

While patients in both the decompression and placebo surgery groups had slightly greater reductions in shoulder pain than those in the no-treatment group, the difference was small and not likely to have a noticeable effect, Carr's team reported Nov. 20 in The Lancet.

In the United States, shoulder pain accounts for 4.5 million doctor visits each year and the new findings question the value of decompression surgery, the researchers said.

"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," Carr said in a journal news release.

"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," he added.

But two specialists in shoulder pain had differing views on the study.

Berend Schreurs works at Radboud University Medical Center in the Netherlands, and wrote an accompanying journal editorial on the study. He said, "Hopefully, these findings from a well-respected research group will change daily practice. The costs of surgery are high, and although the low occurrence of complications might suggest that the surgery is benign, there is no indication for surgery without possible gain."

But a U.S.-based orthopedic surgeon took issue with the study's design, and believes decompression surgery may still have real value.

Dr. Peter McCann directs orthopedic surgery at Lenox Health Greenwich Village in New York City. He said that the study is flawed in that all of the people who were sent to surgery were selected because they had severe cases that had already failed to improve after three months of drugs and/or physiotherapy.

The nonsurgical group were—by nature—not these tougher cases, so McCann believes the comparison between the two groups lacks balance.

"A more rational approach would be to compare these patients who fail nonoperative treatment and undergo surgical treatment with a similar of patients who have failed nonoperative treatment [and are then] followed for an additional 6 months without surgical intervention," he said.

"Only in comparing such groups can one determine if surgical intervention has benefit," McCann said.

Explore further: Good long-term improvement after 'reverse' shoulder replacement in patients under 60

More information: Abstract
Full Text
Editorial

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on shoulder problems.

Related Stories

Good long-term improvement after 'reverse' shoulder replacement in patients under 60

October 26, 2017
For younger patients with severe damage to the rotator cuff muscles, a "reverse" shoulder replacement provides lasting improvement in shoulder function, according to a study in The Journal of Bone & Joint Surgery.

Age not a factor in success of shoulder replacement surgery

March 15, 2017
Whether you're younger than 65 or older than 75, age may not be a discernible factor in the success of shoulder replacement surgery, according to a Henry Ford Hospital study.

Common shoulder dislocation can heal just as well without surgery

October 22, 2015
Acromio-clavicular joint dislocation is one of the most common shoulder injuries orthopedic surgeons treat. Severe dislocations are often treated with surgery, but patients who opt for non-surgical treatment typically experience ...

Study shows surgery reverses pseudoparalysis in patients with rotator cuff tears

March 19, 2017
Research presented at the American Orthopaedic Society for Sports Medicine's (AOSSM) Specialty Day in San Diego shows arthroscopic superior capsule reconstruction (SCR), a surgical approach to treat irreparable rotator cuff ...

No need to delay rotator cuff surgery, study shows

March 28, 2015
Delaying rotator cuff surgery on patients with shoulder stiffness may not be necessary, according to research presented today at the American Orthopaedic Society for Sports Medicine's (AOSSM) Specialty Day.

Shoulder replacement eases pain, improves motion in rheumatoid arthritis patients, study finds

January 13, 2014
Shoulder arthritis is a common problem for rheumatoid arthritis patients: pain and difficulty moving their arms can grow so severe that daily tasks and sleep become difficult. If medication and physical therapy aren't enough, ...

Recommended for you

Screening for colorectal cancer spares male patients from intense treatments

November 21, 2018
While screening for colorectal cancer does not reduce mortality, it does reduce the need for chemotherapy and emergency surgeries among male patients, according to a recent Finnish study.

Rapid response inpatient education boosts use of needed blood-thinning drugs

November 16, 2018
A new study designed to reach hospitalized patients at risk shows that a "real-time" educational conversation, video or leaflet can lower the missed dose rates of drugs that can prevent potentially lethal blood clots in their ...

Race plays role in regaining weight after gastric bypass surgery

November 15, 2018
African Americans and Hispanic Americans who have undergone Roux-en-Y gastric bypass (RYGB) are at greater risk to regain weight as compared to Caucasians. To date, no study has addressed the effect of race on weight regain ...

Surgery, not antibiotics, should remain first-line treatment for appendicitis: study

November 14, 2018
Treating appendicitis with antibiotics as an alternative to surgical removal of the inflamed organ was found to be more costly in the long term and result in higher rates of hospital readmissions, according to a study by ...

Study finds that in treating obesity, one size does not fit all

November 13, 2018
Analyzing data from more than 2,400 obese patients who underwent bariatric weight-loss surgery, researchers identified at least four different patient subgroups that diverge significantly in eating behaviors and rate of diabetes, ...

Surgery patients use only 1/4 of prescribed opioids, and prescription size matters

November 7, 2018
Many surgeons write prescriptions for opioid pain medications four times larger than what their patients will actually use after common operations, a new study shows.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

moeshawalter
not rated yet Nov 30, 2017
It's obvious some patients with HIV/CANCER are been enslaved to the antiviral and other supplementary Orthodox medicine just to help suppress the virus and not a cure. I have been with the virus since 2012 until I was introduce by a blogger who also narrated her story online on how she was cured of Genital Herpes after using Dr ATAKUMA's Herbal Medicine. This is a year and 2 weeks since I was delivered from Herpes. All thanks to God for using this Great herbalist to heal me. I have promise to keep telling good about Dr ATAKUMA. Please fill free to share Your problems with him and don't forget to tell him I did refer you to Him. Thanks. Write him on mail dr.atakumaoracle@outlook.com or whats app him on +2347064693371 he can cure the following.bells palsy,Cancer Hepatitis B ALS. just contact DR now and see what he can do

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.