Read by QxMD icon Read

Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline

Per Olav Vandvik, Tuomas Lähdeoja, Clare Ardern, Rachelle Buchbinder, Jaydeep Moro, Jens Ivar Brox, Jako Burgers, Qiukui Hao, Teemu Karjalainen, Michel van den Bekerom, Julia Noorduyn, Lyubov Lytvyn, Reed A C Siemieniuk, Alexandra Albin, Sean Chua Shunjie, Florian Fisch, Laurie Proulx, Gordon Guyatt, Thomas Agoritsas, Rudolf W Poolman
BMJ: British Medical Journal 2019 February 6, 364: l294

CLINICAL QUESTION: Do adults with atraumatic shoulder pain for more than 3 months diagnosed as subacromial pain syndrome (SAPS), also labelled as rotator cuff disease, benefit from subacromial decompression surgery? This guideline builds on to two recent high quality trials of shoulder surgery.

CURRENT PRACTICE: SAPS is the common diagnosis for shoulder pain with several first line treatment options, including analgesia, exercises, and injections. Surgeons frequently perform arthroscopic subacromial decompression for prolonged symptoms, with guidelines providing conflicting recommendations.

RECOMMENDATION: The guideline panel makes a strong recommendation against surgery.

HOW THIS GUIDELINE WAS CREATED: A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines and the GRADE system. The recommendation is based on two linked systematic reviews on ( a ) the benefits and harms of subacromial decompression surgery and ( b ) the minimally important differences for patient reported outcome measures. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of surgery in multilayered evidence summaries and decision aids available in MAGIC ( to support shared decisions and adaptation.

THE EVIDENCE: Surgery did not provide important improvements in pain, function, or quality of life compared with placebo surgery or other options. Frozen shoulder may be more common with surgery.

UNDERSTANDING THE RECOMMENDATION: The panel concluded that almost all informed patients would choose to avoid surgery because there is no benefit but there are harms and it is burdensome. Subacromial decompression surgery should not be offered to patients with SAPS. However, there is substantial uncertainty in what alternative treatment is best.


You need to log in or sign up for an account to be able to comment.

No comments yet, be the first to post one!

Related Papers

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"