Dr. Andrew Carr from Oxford University said the surgery might not be clinically significant over no treatment, and the decompression surgery would not be beneficial over placebo surgery.
The subacromial pain therapy comprises decompressing the subacromial space by removing bone spurs and soft tissue arthroscopically. The decompression surgery is one of the most common surgeries in orthopedics.
However, the procedure had never been verified in a placebo-controlled trial. So, the researchers enrolled people who had intact rotator cuff tendons but had experienced subacromial pain for at least three months, despite physical therapy and steroid injections.
The team randomly assigned the people to decompression surgery, arthroscopy without removing any tissue, and no treatment group. Later, surgery participants had one to four physical therapy sessions and those having no treatment had a check-up appointment 90 days after the start of the trial.
The baseline score of the pain in those who underwent decompression surgery was increased from a mean of 25.2 to 32.7 points (at 180 days). The baseline score was improved from a mean of 26.7 to 34.2 points in the people who had arthroscopy alone.
Among those who had no treatment, baseline score increased from a mean of 25.5 to 29.4 points. There was no statistically significant difference between the two surgery groups.
However, the score difference between those who received decompression surgery and those who received no treatment was statistically significant, as was the difference between those who received arthroscopy and those who received no treatment.
At one year, the score of pain remained the same among the groups. According to the authors, the difference between surgery and no treatment were not clinically important in any event.
Co-author of the study, David Beard said, "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."
Dr. Berend Schreurs and Stephanie L. van der Pas wrote, "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."
The study findings would help to change daily practice. The study suggested that even if the low occurrence of complications, the surgery is benign, there is no indication for surgery without possible gain.
The study results were convincing; the surgery was not clinically significant over no treatment and that the decompression surgery was not beneficial over placebo surgery.