An international panel of experts has recommended that sub-acromial decompression surgery should not be offered to patients with sub-acromial pain syndrome. However, they point out that there is substantial uncertainty around what would be a better alternative treatment.
The recommendation is based on two systematic evidence reviews, one on the benefits and harms of decompression surgery and the second on meaningful improvements in pain, movement and quality of life valued by patients. These reviews found that surgery did not provide important improvements in pain, function or quality of life compared with placebo surgery or other options. They also found frozen shoulder may be more common with surgery.
The panel concluded that almost all well-informed patients with shoulder pain would decline surgery and therefore made a strong recommendation against sub-acromial decompression surgery. “Clinicians should not offer patients subacromial decompression surgery unprompted, and clinicians, public healthcare providers, and others should make efforts to educate the public regarding the ineffectiveness of surgery,” they said.
The new guidance is part of the BMJ Rapid Recommendations initiative.