Experts Advise Against Shoulder Surgery for Rotator Cuff Disease

A panel of experts recently released a clinical practice guideline strongly recommending against operative treatment for patients with subacromial pain syndrome (SAPS), also labelled as rotator cuff disease.

“SAPS is the common diagnosis for shoulder pain with several first line treatment options, including analgesia, exercises, and injections,” the panel wrote in The BMJ. “Surgeons frequently perform arthroscopic subacromial decompression for prolonged symptoms, with guidelines providing conflicting recommendations.”

Shoulder Surgery Does Not Improve Pain, Function Outcomes

Per their findings, surgery was not associated with improvements in pain, function, or quality of life when compared to patients who received placebo surgery or sought alternative treatment options. Operative patients may also have increased risk for frozen shoulder, they noted.

The final analysis included data from seven randomized, controlled trials including a total of 1,014 patients (mean age at baseline, 49.1 years; mean symptom duration prior to enrollment, 2.1 years).

The researchers analyzed and compared the benefits and harms associated with subacromial decompression surgery versus nonoperative management. There were no significant between-group differences for the operative group and nonoperative management patients in mean outcomes for:

  • Visual analog scale pain score (2.6 vs. 2.9)
  • Constant score scale, function (72 vs. 69)
  • EQ-5D scale, quality of life (0.70 vs. 0.73)
  • Events per 1,000 people (global perceived effect, 699 vs. 635; at work, 859 vs. 818)

In terms of events per 1,000 people, there were six serious harms in the surgical group, but none in the nonoperative management group.

Shoulder Pain Patients ‘Do Need Support and Compassion’—But Maybe Not Surgery

“Shoulder pain can be excruciating and patients do need support and compassion,” Dr. Rudolf Poolman, the study’s senior author and an orthopedic surgeon scientist in the department of orthopedic surgery at OLVG in Amsterdam, told Reuters. “The evidence shows that surgery works as well as a placebo surgery or physiotherapy. Surgeons should realize this and reassure the patient that the pain will subside eventually and that surgery has potential side effects that can make matters worse.”

Evidence does not exist to prove that surgery benefits patients with tendinopathy, Poolman added to Reuters: “Shoulder pain is multifactorial and also factors not related to the shoulder – such as psychological and social factors – are very important to take into account.”

The researchers wrote in their paper: “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. Although we did not take costs and resources into account beyond direct costs to patients (such as out-of-pocket costs), surgery cannot be cost effective given the lack of important benefit, potential for harm, and associated costs.”

Comparison of 90-Day Perioperative Outcomes in Shoulder Arthroplasty Between the Elderly and Nonelderly Patients

Genetic variants involved in extracellular matrix homeostasis play a role in the susceptibility to frozen shoulder: a case–control study

Reverse Shoulder Arthroplasty in Acute Fractures of the Proximal Humerus: Does Tuberosity Healing Improve Clinical Outcomes?

Model‐based RSA is suitable for clinical trials on the glenoid component of reverse total shoulder arthroplasty

Source: The BMJ