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

05-09-2019
BMJ 2019

Do adults with traumatic shoulder pain diagnosed for more than 3 months as subacromial pain syndrome (SAPS), also referred to as rotator cuff disease, benefit from subacromial decompression surgery? This is the clinical question that is being asked and the guideline that builds on two recent high-quality studies of shoulder surgery.

With regard to shoulder pain, SAPS is the general diagnosis with various first-line treatment options, including analgesia, exercises and injections.
In accordance with standards for reliable guidelines and the GRADE system, a target panel with patients, clinicians and methodologists has drawn up this recommendation. The recommendation is based on two linked systematic reviews on (a) the advantages and disadvantages of subacromial decompression surgery and (b) the minimal important differences in outcome measures reported by patients.

Visual reviews make recommendations feasible for clinicians and their patients. They present the relative and absolute advantages and disadvantages of surgery in the form of multilayer summaries of evidence and decision-making tools available in MAGIC (www.magicapp.org) to support shared decisions and adaptation.

Surgery did not produce any significant improvements in pain, function or quality of life compared to placebo surgery or other options. Frozen shoulder can occur more often during operations. The guideline panel makes a strong recommendation against operations. The panel concluded that, since it is not an advantage and improves too many disadvantages, almost all informed patients choose to avoid operations.

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