Subacromial Decompression Vs Sham

Paavola M et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomized placebo surgery controlled clinical trial. BJSM 2018
  • Purpose of study was to determine efficacy of arthroscopic subacromial decompression in pts with symptoms consistent with impingement syndrome
  • Participants were enrolled from three orthopedic clinics in Finland b/w 2/05 and 6/2015. Age 35-65 with shoulder symptoms of at least 3 months duration and unresponsive to traditional conservative care w/ findings consistent with shoulder impingement
  • At baseline, pts were randomized to either surgery or exercise therapy (71) at a 2:1 ratio. A second randomization assigned participants to either the SAD group (59) or diagnostic arthroscopy (63)
  • Primary outcome measures were pain at rest and pain with movement in 24 months. Secondary outcome measures were functional scales including the Constant-Murley score and the simple shoulder test
  • Exercise therapy consisted of a standardized program with daily home exercises and 15 sessions one on one with a PT
  • Both surgical groups improved from baseline at 24 months but no significant between group differences existed in either pain at rest or pain with activity or with the secondary outcome measures.
  • Interestingly, patients in either group were no more likely to guess whether or not they had undergone the placebo procedure
  • In the secondary comparison (ASD versus exercise therapy), statistically significant differences were found in favor of ASD in the two primary outcomes at 24 months in both VAS at rest and VAS on arm activity but the mean differences between groups did not exceed the pre-specified minimal clinically important difference. 
  • The results of this controlled trial show that arthroscopic subacromial decompression provides no clinically relevant benefit over diagnostic arthroscopy in patients with shoulder impingement syndrome. The findings do not support the current practice of performing subacromial decompression in patients with shoulder impingement syndrome.
  • “When SAD was proven futile under this best case scenario, there is no reason to assume that it would work better under less optimal circumstances or in a more heterogeneous population.”