Is a Widespread Shoulder Surgical procedure Ineffective?

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By Robert Preidt

HealthDay Reporter

TUESDAY, Nov. 21, 2017 (HealthDay Information) — New analysis casts doubt on the true effectiveness of a typical kind of surgical procedure used to ease shoulder ache.

A British analysis group tracked outcomes for sufferers who underwent “decompression surgical procedure” to deal with shoulder impingement — a situation the place a shoulder tendon rubs and catches within the joint.

In decompression surgical procedure, a small space of bone and smooth tissue within the shoulder joint is eliminated, opening up the joint to stop the abrasion that occurs when the arm is lifted.

All the sufferers had suffered shoulder ache for at the least three months regardless of nonsurgical approaches, together with physiotherapy and steroid injections.

So, the sufferers have been then despatched to decompression surgical procedure (90 sufferers), a placebo surgical procedure the place they thought they bought the process however did not (94 sufferers), or no remedy (90 sufferers).

Within the placebo surgical procedure, the surgeons seemed contained in the joint however didn’t take away any tissue.

Each teams of surgical procedure sufferers additionally had one to 4 physiotherapy classes afterwards. These within the no-treatment group had solely a check-up three months after the beginning of the examine.

Six to 12 months after coming into the examine, shoulder ache signs had eased in all three teams of sufferers, no matter whether or not they bought the surgical procedure or not, famous a group led by Andrew Carr of the College of Oxford.

Whereas sufferers in each the decompression and placebo surgical procedure teams had barely larger reductions in shoulder ache than these within the no-treatment group, the distinction was small and never prone to have a noticeable impact, Carr’s group reported Nov. 20 in The Lancet.

In america, shoulder ache accounts for four.5 million physician visits annually and the brand new findings query the worth of decompression surgical procedure, the researchers stated.

“Over the previous three a long time, sufferers with this type of shoulder ache and clinicians have accepted this surgical procedure within the perception that it gives dependable reduction of signs, and has low threat of hostile occasions and problems,” Carr stated in a journal information launch.


“Nonetheless, the findings from our examine recommend that surgical procedure may not present a clinically vital profit over no remedy, and that there is no such thing as a good thing about decompression over placebo surgical procedure,” he added.

However two specialists in shoulder ache had differing views on the examine.

Berend Schreurs works at Radboud College Medical Middle within the Netherlands, and wrote an accompanying journal editorial on the examine. He stated, “Hopefully, these findings from a well-respected shoulder analysis group will change day by day observe. The prices of surgical procedure are excessive, and though the low prevalence of problems may recommend that the surgical procedure is benign, there is no such thing as a indication for surgical procedure with out potential acquire.”

However a U.S.-based orthopedic surgeon took problem with the examine’s design, and believes decompression surgical procedure should have actual worth.

Dr. Peter McCann directs orthopedic surgical procedure at Lenox Well being Greenwich Village in New York Metropolis. He stated that the examine is flawed in that the entire individuals who have been despatched to surgical procedure have been chosen as a result of they’d extreme instances that had already failed to enhance after three months of medication and/or physiotherapy.

The nonsurgical group have been — by nature — not these harder instances, so McCann believes the comparability between the 2 teams lacks steadiness.

“A extra rational method can be to match these sufferers who fail nonoperative remedy and endure surgical remedy with an analogous group of sufferers who’ve failed nonoperative remedy [and are then] adopted for an extra 6 months with out surgical intervention,” he stated.

“Solely in evaluating such teams can one decide if surgical intervention has profit,” McCann stated.

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