Common shoulder surgery no better than placebo

Arthroscopic decompression surgery for shoulder pain has been called into question by new research in The Lancet that finds the procedure is no better than placebo.

The UK study involved people with shoulder pain for at least three months, despite having physiotherapy and steroid injections, who were randomised to arthroscopic subacromial decompression (n=90), investigational arthroscopy only (n=94)  or no treatment (n=90).

At six months, those in the decompression and placebo surgery groups rated their pain and function at a similar level, with no statistical difference (32.7 points and 34.2 points, respectively).

While both forms of surgery showed a small benefit over no treatment (rated at 29.4 points in the no treatment group) the authors said the difference was unlikely to result in a noticeable difference in symptoms and was likely to be attributed to a placebo effect or postoperative physiotherapy.

Noting some limitations to the study the authors concluded that their findings called into question the value of offering the common surgery to patients.

“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.

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 investigator Professor Andrew Carr from the University of Oxford in the UK.

Writing in a linked Comment, Dr Berend Schreurs, Radboud University Medical Center, the Netherlands, says “The findings send a strong message that the burden of proof now rests on those who wish to defend the standpoint that shoulder arthroscopy is more effective than non-surgical interventions.

Hopefully, these findings from a well respected shoulder 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.”

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