Subacromial pain syndrome (SAPS) is the most common diagnosis for shoulder pain. Subacromail decompression, which is the removal of the subacromial bursa with some bone from the anteroinferior surface of the acromion is a common treatment option for SAPS in order to prevent impingement of the rotator cuff tendons. Although the decision of whether or not to perform surgery is not in our physiotherapy hands, it is interesting to gain insight into the benefits and/or possible harm of this type of surgery when compared to exercise therapy or placebo surgery.
In a recent systematic review of Lähdeoja et al. (2019), they tried to determine the possible differences between subacromial decompression surgery and placebo surgery or exercise therapy in adults who suffered from SAPS for 3 months or more. Placebo surgery consisted of a diagnostic arthroscopy. They found that subacromial decompression surgery:
- does not provide additional benefits over placebo surgery with respect to pain, physical function or quality of life at 6 months and 1-2 year post surgery
- probably carries a small risk of serious harms (deep vein thrombosis, pulmonary embolism, pneumonia,…)
- probably provides a small but likely unimportant improvement in pain and may not improve physical function when compared to exercise therapy
Conclusion: the role of subacromial decompression surgery should be reconsidered since no important benefit is provided compared to placebo surgery or exercise therapy.
Reference: Lähdeoja T, Karjalainen T, Jokihaara J, Salamh P, Kavaja L, Agarwal A, Winters M, Buchbinder R, Guyatt G, Vandvik PO, Ardern CL. Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis. Br J Sports Med. 2019 Jan 15.
Written by: Dorien Borms