Breaking News
February 23, 2018 - Tobacco Kills, No Matter How It’s Smoked: Study
February 23, 2018 - Q&A: Avindra Nath, MD | Medpage Today
February 23, 2018 - Adherence to sleep apnea treatment affects risk of hospital readmission
February 23, 2018 - Zika virus could be alternative for treatment of aggressive brain cancer
February 23, 2018 - Carbon monoxide enhances efficacy of antibiotic against stomach infection
February 23, 2018 - MSD and Ferring Pharmaceuticals Complete Largest Ever Clinical Trial in Postpartum Haemorrhage
February 23, 2018 - Postnova AF2000 system offers reliable characterization of trace metal colloid distribution in the environment
February 23, 2018 - Pioneering study may pave way for effective painkillers to treat neuropathic pain
February 23, 2018 - Research opens up new avenue to minimize risks of transplants
February 22, 2018 - Cabozantinib Active in Advanced Thyroid Cancer
February 22, 2018 - Polluted air may pollute our morality
February 22, 2018 - New data from VOYAGE 2 trial shows promising results for Janssen’s guselkumab treatment
February 22, 2018 - Bank loans signed in the hospital leave patients vulnerable
February 22, 2018 - Researchers identify new nanostructure inside sperm tails
February 22, 2018 - Catheter-based procedure increases treatment options for mitral valve disease
February 22, 2018 - Sage Therapeutics Receives FDA Breakthrough Therapy Designation for SAGE-217 for the Treatment of Major Depressive Disorder
February 22, 2018 - Larger Endocarditis Vegetations More Likely to Embolize, Kill
February 22, 2018 - Parenting behavior in adoptive families
February 22, 2018 - Researchers discover new weakness in sleeping sickness parasites
February 22, 2018 - Research project aims to find new ways to identify and treat most aggressive brain cancers
February 22, 2018 - Researchers explore how people with Alzheimer’s disease use end-of-life medical services
February 22, 2018 - Stroke survivors and carers feel marginalized due to lack of support from primary care
February 22, 2018 - Neuroscientists discover novel mechanism of action behind schizophrenia
February 22, 2018 - After shooting, ‘honor how kids want to deal with their feelings’
February 22, 2018 - U.S., EU and Japan Health Authorities Accept Regulatory Submissions For Review Of Pfizer’s Third-generation ALK Inhibitor Lorlatinib
February 22, 2018 - At-Home Genetic Test Might Change Medicine
February 22, 2018 - Many second hand plastic toys could pose a risk to children’s health, study suggests
February 22, 2018 - Study shows that two different brain systems cooperate during learning
February 22, 2018 - Liquefied brain tissue after stroke may harm surviving brain, UA study finds
February 22, 2018 - New intervention improves communication behaviors in couples affected by dementia
February 22, 2018 - Clinical trial shows safety of promising TSRI stroke drug
February 22, 2018 - Researchers discover new interaction mechanism of unstructured proteins
February 22, 2018 - A Patient’s Journey: Can I Kill the Glucose Monster?
February 22, 2018 - The Problem That Piles Up
February 22, 2018 - Kids can roll up their sleeves—again—for mumps protection
February 22, 2018 - Scientists find significant amounts of toxic metals in e-cigarette vapors
February 22, 2018 - 3D Signatures reports positive results of new Telo-HL test for Hodgkin’s lymphoma
February 22, 2018 - Scientists reveal development of improved medicine to fight addiction
February 22, 2018 - USC-led researchers release dataset of brain scans from stroke patients
February 22, 2018 - Antibiotic-producing bacterium releases more metabolites than assumed
February 22, 2018 - Flu Season Shows First Signs of Slowing
February 22, 2018 - Nonstick Chemicals May Disrupt Metabolic Function in Women
February 22, 2018 - Calcium may play a role in the development of Parkinson’s disease
February 22, 2018 - Scientists visualize insulin receptor activation for the first time
February 22, 2018 - UC San Diego Health now offers new treatment option for people with refractory epilepsy
February 22, 2018 - First African child vaccinated with new typhoid conjugate vaccine
February 22, 2018 - BetterYou named as ‘Most Innovative Brand’ at FGB Awards 2018
February 22, 2018 - Assaults Among Young People Fall to Lowest Rate in 15 Years
February 22, 2018 - What do you know about Parkinson’s disease?
February 22, 2018 - Researchers discover five new genetic changes that may increase pancreatic cancer risk
February 22, 2018 - Gout medication may help improve heart function in adult patients
February 22, 2018 - Bioactive compound limits collateral damage in the kidneys after heart attack
February 22, 2018 - Study reveals HCT as effective treatment for NHL patients regardless of age
February 22, 2018 - Father’s age can affect offspring lifespan, mice study shows
February 22, 2018 - Opiant Pharmaceuticals Announces Publication of New Pre-Clinical Data Supporting Potential of OPNT005 as a Heroin Vaccine
February 22, 2018 - Make the Diagnosis: Strange Rash Surfaces
February 22, 2018 - Isolated sulfite oxidase deficiency – Genetics Home Reference
February 22, 2018 - Scientists identify weight loss ripple effect
February 22, 2018 - Smoking at record lows in New York
February 22, 2018 - Scientists pinpoint fertility hormone that could support early pregnancy
February 22, 2018 - Aggressive cancer stem cells can now be isolated successfully in a scientific breakthrough
February 22, 2018 - Researchers find high risk of suicide among unaccompanied refugee minors
February 22, 2018 - Protein levels linked to posture and gait problems in Parkinson’s
February 22, 2018 - Biomedical engineers create 3D hydrogel scaffolds  to transform cells into muscle
February 22, 2018 - Study employs novel approach to uncover new biomarker for CHD
February 22, 2018 - Study finds strong connection between midwifery and birth outcomes
February 22, 2018 - Verastem Submits NDA to FDA for Duvelisib for the Treatment of Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Follicular Lymphoma
February 22, 2018 - Low BP Associated With Risk in HFpEF
February 22, 2018 - More U.S. women obese before pregnancy, experts sound the alarm
February 22, 2018 - Study aims to examine effects of PTSD symptoms in police officers
February 22, 2018 - Study reveals increased disease risk after early heart surgery
February 22, 2018 - Women with Type 1 diabetes come across unique challenges
February 22, 2018 - Researchers target abnormal epigenetic mechanisms involved in childhood cancers
February 22, 2018 - Wine polyphenols may be good for oral health
February 22, 2018 - Moderate and severe exacerbations associated with decline in physical activity of COPD patients
February 22, 2018 - FDA Approves Osmolex ER (amantadine) for the treatment of Parkinson’s Disease and Drug-Induced Extrapyramidal Reactions
February 22, 2018 - Morning Break: NSCLC Approval; School Nurses; ‘Human-Sheep Hybrids’?
February 22, 2018 - Penn study sheds new light on immune cell identity
February 22, 2018 - From a novel support group to a book, learning from seven widowed fathers
February 22, 2018 - Researcher makes breakthrough discovery in process of fear relapse
Decompression surgery may offer no additional benefit for people with shoulder impingement

Decompression surgery may offer no additional benefit for people with shoulder impingement

image_pdfDownload PDFimage_print

Decompression surgery does not reduce shoulder pain any more than placebo surgery for people with shoulder impingement – when the tendon rubs and catches in the joint, according to the first placebo-controlled trial in shoulder surgery published in The Lancet.

Furthermore, although both types of surgery were slightly more effective at reducing subacromial shoulder pain compared to no treatment, the difference was small and not likely to result in a noticeable effect.

In the USA, shoulder pain accounts for 4.5 million visits to the doctor each year, and 2.4% of all GP visits in the UK. For subacromial shoulder pain, treatment options include subacromial decompression, which is one of the most commonly used surgeries in orthopedics. In England, the number of surgeries has risen from 2523 in 2000, to 21355 in 2010.

The authors of the study say the findings question the value of this operation, and that patients considering undergoing the operation should be informed.

“Over the past three decades, patients with this form of shoulder pain and clinicians have accepted this surgery in the belief that it provides reliable relief of symptoms, and has low risk of adverse events and complications. However, the findings from our study suggest that surgery might not provide a clinically significant benefit over no treatment, and that there is no benefit of decompression over placebo surgery.” says co-chief investigator Professor Andrew Carr, National Institute of Health Research (NIHR) Biomedical Research Centre, University of Oxford, UK.

The study involved 32 hospitals and 51 surgeons across the UK. In the study, 90, 94 and 90 people who had suffered shoulder pain for at least three months despite having physiotherapy and steroid injections underwent decompression surgery, placebo surgery or no treatment, respectively. They completed questionnaires about their level of pain and function at six months.

Decompression surgery is a keyhole surgery that involves removing a small area of bone and soft tissue in the shoulder joint to open up the joint and prevent rubbing or catching when the arm is lifted. In the placebo surgery, surgeons conducted a procedure to look inside the joint where the joint was inspected but no tissue was removed.

Both surgeries were completed as keyhole procedures to ensure that patients were not aware of which surgery they had had. Surgery participants also had one to four physiotherapy sessions afterwards, while those having no treatment only had a check-up appointment three months after the start of the trial.

Six and 12 months after they entered the trial, the participants completed questionnaires rating their symptoms, including pain (from 0-48, with a higher number meaning less pain). Overall, symptoms diminished in all three groups from the start of the trial.

At six months, people who had had decompression surgery and those who had had placebo surgery rated their pain and function at a similar level, with no statistical difference (32.7 points and 34.2 points, respectively).

Comparatively, both forms of surgery showed a small benefit over no treatment (rated at 29.4 points in the no treatment group), however, the difference is unlikely to result in a noticeable difference in symptoms.

The authors suggest that the difference could be attributable to a number of factors, including a placebo effect related to surgery, a nocebo effect related to having no treatment, other unintended effects of the placebo surgery, or because people undergoing surgery were given physiotherapy and told to rest.

“Our findings call into question the value of shoulder decompression surgery for this group of patients, and should be communicated to patients and doctors considering this type of surgery. In light of our results, other ways to treat shoulder impingement could be considered, such as painkillers, physiotherapy and steroid injections.” says co-chief investigator Professor David Beard, University of Oxford, UK.

During the trial, six participants had a frozen shoulder (two people in each treatment group) related to the study, and one person in the placebo surgery group underwent decompression surgery for pain.

The authors note some limitations to their study, including that some patients did not continue with their assigned treatment (23%, 42% and 12% of decompression, placebo surgery and no treatment participants, respectively). For example, some patients assigned to surgery did not undergo treatment as their symptoms improved, and other patients assigned to no treatment chose to undergo decompression surgery. However, the authors found that the effects of this do not impact on the results.

In addition, there were long waiting times within the study meaning some people who had only recently had surgery and may have still been recovering were compared with people who had had no treatment for six months, which may affect the results. On average, people assigned to decompression surgery waited 90 days for their surgery, and people assigned to placebo surgery waited 82 days.

The study did not look at the recurrence of pain after a year, but the authors state that it is unlikely that one group would show larger improvements long-term when they have not done so in a year after surgery.

Writing in a linked Comment, Dr Berend Schreurs, Radboud University Medical Center, the Netherlands, says:

The findings send a strong message that the burden of proof now rests on those who wish to defend the standpoint that shoulder arthroscopy is more effective than non-surgical interventions. Hopefully, these findings from a well respected shoulder research group will change daily practice. The costs of surgery are high, and although the low occurrence of complications might suggest that the surgery is benign, there is no indication for surgery without possible gain.

Source:

http://www.thelancet.com/

Tagged with:

About author

Related Articles