Arthroscopic Subacromial Decompression Doesn't Relieve Pain

Arthroscopic subacromial decompression (ASD) — arthroscopic removal of bone spurs and soft tissue to enlarge the subacromial space and reduce impingement on rotator cuff tendons — is an increasingly common procedure for managing shoulder pain, but its effectiveness is uncertain.

Researchers in the U.K. randomized 313 patients with subacromial pain of at least 3 months' duration and intact rotator cuff tendons to ASD, investigational arthroscopy only (a sham procedure), or no treatment. All patients received exercise therapy and at least one steroid injection before randomization. Patients in the ASD and arthroscopy-only groups received advice and one to four physiotherapy treatments after surgery; those in the no-treatment group received only one reassessment visit with a shoulder specialist, at 3 months after randomization. All patients completed the Oxford Shoulder Score (OSS) questionnaire, a 48-point measure of pain and function (higher scores are better), at baseline and at 6 and 12 months after randomization.

After 6 months, mean OSS did not differ between the ASD and arthroscopy-only groups (32.7 and 34.2, respectively) and, although both procedure groups attained a statistically significant benefit over the no-treatment group (mean OSS, 29.4), the difference was clinically unimportant. All three groups showed significant improvements over baseline in OSS at both 6 and 12 months.