Which Shoulder Intervention Works Best?

Shoulder pain is one of the most annoying of orthopedic issues—in part because it interferes with such mundane activities as driving a car or getting dressed.

Treating shoulder pain ranges from taking pain pills and engaging in physical therapy to undergoing surgery. According to Nicky Broyd, writing for WebMD, 2.4% of all visits to doctors in the United Kingdom, take place because of shoulder pain. The article is titled “Doubts over common shoulder op.”

When over-the-counter drugs and physical therapy fail to relieve pain, doctors have proscribed decompression keyhole surgery which involves the cutting off of a small area of bone and tissue to “open up the joint.” Broyd writes that tens of thousands of patients undergo this surgery each year in the UK.

But does it work? A 32 hospital, 51 surgeon study was launched in the UK to see if an answer to that question exists. Participating patients had to have had shoulder pain for at least three months despite having physiotherapy and steroid injections. They were divided into three groups.

Group one consisted of 90 people who had had decompression keyhole surgery in which tissue was removed.

Group two consisted of 94 people who had had placebo keyhole surgery in which surgeons had inspected the joint but did not remove any tissue.

Group three consisted of 90 people had had no surgical treatment.

According to Broyd, the surgery patients were unaware which surgery they had undergone and had to have physiotherapy sessions afterwards. Six and 12 months after they entered the trial, the participants completed questionnaires rating their symptoms, including pain.

At six months, participants in all three groups said they had less pain. At six months, patients who had decompression surgery and those who had placebo surgery rated their pain and function at a similar level. Both forms of surgery showed a small but not significant benefit over no treatment.

Broyd reports that, “The researchers believe their findings question the value of the operation, and they say patients considering decompression surgery should be informed.”

Natalie Carter, head of research liaison and evaluation at Arthritis Research UK said in a statement, “Many people with shoulder pain are treated with, and will respond to, non-operative treatment alone. However surgery is often used as a treatment. In 2010, over 21,000 people had this type of surgery in England—an increase of nearly 750% in 10 years.