In this article, we will discuss subacromial decompression surgery and the rotator cuff.
One example of shoulder pain is damage to the rotator cuff.The rotator cuff plays a role in the stability of the humerus and scapula, and if you are a muscle training enthusiast, it is so well known that you can slur your words about the four muscles that make up the rotator cuff.However, shoulder pain is not only caused by damage to the rotator cuff, but can also originate from damage to the adjacent soft tissues.
One of them is the acromion, a bony index that can be palpated from the surface of the body slightly above where the humerus and scapula articulate.Just below the acromion are soft tissues such as ligaments and bursae, which help the upper arm move smoothly.The review presented here compares subacromial decompression with no surgery.
The studies
These studies were conducted in hospitals in Denmark, Finland, Germany, Norway, Sweden, and the United Kingdom.They included 1062 participants from eight trials that compared surgery with placebo (sham) surgery or other non-surgical treatments such as exercise for people with shoulder rotator cuff tears.The average age of participants ranged from 42 to 65 years, with follow-up periods of about 1 to 12 years.Five trials failed to report their funding source, three were funded by a non-profit foundation and one trial author was paid by a measurement company.
As a result, two trials (506 participants) compared surgery with placebo.
The results suggested that subacromial decompression offered little benefit at 1-year follow-up.
In terms of pain, (lower score means less pain)
3% (3% worse to 8% better) or 0.26 points on a scale of 0 to 10.
Participants who received the placebo procedure rated their own pain at 2.9 points.
Participants who underwent surgery rated their pain at 2.6 points.
In terms of functionality (0-100: a higher score means better functionality)
3% (1% worse to 7% better) or 3 points better
Participants who received the placebo procedure rated their own functionality at 69 points.Participants who received the surgery rated their own functionality at 72 points.Participants who had surgery rated their own functionality at 72 points.
5% of participants said the treatment was successful, (5% less to 16% more) or 5/100 participants said it was successful.
66/100 people said the treatment was successful after the placebo procedure.71/100 people said that the surgery was successful.
In terms of quality of life (a higher score means a better quality of life)
-2% worse (8% worse to 4% better) or 0.02 points better on a scale of 0.59/1.
Participants who received the placebo procedure rated their quality of life at 0.73 points.Participants who underwent surgery rated their quality of life at 0.71 points.
In terms of adverse events.
1% fewer people (4% fewer to 3% more) reported experiencing an adverse event from the surgery.
4/100 patients reported adverse events after placebo surgery.
3/100 patients reported adverse events after surgery.
In terms of serious adverse events, no serious adverse events were reported from these studies.In observational studies, the incidence of serious adverse events ranged from 0.5% to 0.6%.
Reviewer's conclusions
The data in this review do not support the use of subacromial decompression in the treatment of rotator cuff disease presenting as painful shoulder impingement. Evidence with a high degree of certainty indicates that subacromial decompression does not provide a clinically important benefit over placebo in pain, function, or health-related quality of life. Including the results of open-label studies (which have a higher risk of bias) did not change the estimates significantly. Due to imprecision, we downgraded the certainty of the evidence to moderate in order to assess the success of the treatment globally. Compared to placebo, exercise, or non-surgical treatment, there was probably no clinically important benefit to this outcome.
The incidence of adverse events was low, less than 3% across the treatment arms of the study. This is consistent with the incidence of adverse events reported in the two observational studies. The risk of serious adverse events may be less than 1%, although exact estimates are not available.
Karjalainen TV, Jain NB, Page CM, Lähdeoja TA, Johnston RV, Salamh P, Kavaja L, Ardern CL, Agarwal A, Vandvik PO, Buchbinder R. Subacromial decompression surgery for rotator cuff disease. Subacromial decompression surgery for rotator cuff disease. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD005619. DOI: 10.1002/14651858.CD005619.pub3.
Conclusion
These studies suggested that there is little or no benefit to subacromial decompression.The most common indication is impingement syndrome, which is somewhat different from the rotator cuff injury that was the subject of the study.
However, the results of these studies suggest that it is difficult to expect better results despite the differences in diseases, so it is necessary to consider the treatment method.Depending on the condition of the bones and soft tissues, treatment may be given by arthroscopic or other methods, but we also hear of cases where treatment is done conservatively.
Whatever the case may be, there are benefits and risks associated with each method, but we should be very careful about the method we choose.
