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Review
Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis
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  1. Tuomas Lähdeoja1,2,
  2. Teemu Karjalainen1,3,
  3. Jarkko Jokihaara1,4,
  4. Paul Salamh5,
  5. Lauri Kavaja6,7,
  6. Arnav Agarwal8,
  7. Marinus Winters9,
  8. Rachelle Buchbinder3,
  9. Gordon Guyatt10,
  10. Per Olav Vandvik11,12,
  11. Clare L Ardern13,14
  1. 1 Finnish Centre for Evidence-Based Orthopedics (FICEBO), University of Helsinki, Helsinki, Finland
  2. 2 Department of Orthopaedics and Traumatology, HUS Helsinki University Hospital, Helsinki, Finland
  3. 3 Monash Department of Clinical Epidemiology, Cabrini Institute; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia
  4. 4 Department of Hand Surgery, Tampere University Hospital, Tampere, Finland
  5. 5 College of Health Sciences, University of Indianapolis, Indianapolis, Indiana, USA
  6. 6 Medical Faculty, University of Helsinki, Helsinki, Finland
  7. 7 Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
  8. 8 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  9. 9 Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  10. 10 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  11. 11 Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
  12. 12 Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
  13. 13 Division of Physiotherapy, Linköping University, Linköping, Sweden
  14. 14 School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Tuomas Lähdeoja, Department of Orthopaedics and Traumatology, Helsinki University Hospital, PL 00029 HUS, Helsinki, Finland; tuomas.lahdeoja{at}hus.fi

Abstract

Objective To determine the benefits and harms of subacromial decompression surgery in adult patients with subacromial pain syndrome lasting for more than 3 months.

Design Systematic review with meta-analysis.

Main outcome measures Pain, physical function and health-related quality of life.

Data sources Systematic searches for benefits and harms were conducted to 23 July 2018 in MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Database of Abstracts of Reviews of Effects, and Health Technology Assessment.

Eligibility criteria for selecting studies Randomised controlled trials comparing subacromial decompression surgery for subacromial pain syndrome with any other treatment(s). For harms, we included prospective cohort studies.

Review methods Two reviewers independently determined eligibility, extracted the data and assessed the risk of bias of eligible studies. Thirty patients seeking primary or outpatient care for subacromial pain syndrome and a parallel guideline committee (BMJ Rapid Recommendations) provided input regarding systematic review design and interpretation.

Results There was high certainty evidence of no additional benefit of subacromial decompression surgery over placebo surgery in reducing pain at 1 year following surgery (mean difference [MD] −0.26, 95% CI −0.84 to 0.33, minimally important difference [MID] 1.5) or improving physical function at 1–2 years (MD 2.8, 95% CI −1.4 to 6.9, MID 8.3). There was moderate certainty evidence for no additional benefit of subacromial decompression surgery on health-related quality of life at 1 year (MD −0.03 points, 95% CI −0.11 to 0.06, MID 0.07). There was moderate certainty evidence for six serious harms per 1000 (95% CI 5 to 7) patients undergoing subacromial decompression.

Conclusion Subacromial decompression surgery provided no important benefit compared with placebo surgery or exercise therapy, and probably carries a small risk of serious harms.

Systematic reviewregistration number CRD42018086862.

  • shoulder
  • rotator cuff
  • arthroscopic surgery
  • exercise rehabilitation

https://doi.org/10.1136/bjsports-2018-100486

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    Footnotes

    • Contributors TL, CLA and MW conceived of and designed the study. JJ, TK, POV, RB and GG provided critical feedback on the design. TL, CLA and JJ designed and coordinated the direct patient involvement. Screening and study selection: TL and JJ for benefits, and PS, LK, AA and TL for harms. Data extraction: JJ and TK for benefits, and PS, LK, AA, TL and CLA for harms. TL and TK performed the data analyses, and CLA and POV took part in the interpretation of the analyses for benefits. CLA analysed the data for harms. TL, CLA and POV performed risk of bias and certainty of evidence assessments. TL and CLA wrote the manuscript. MW, TK, JJ, RB, POV and GG critically revised the manuscript. All authors approved the final version of the manuscript. TL, TK and RB coordinated the parallel reviews. TL is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval Patient involvement in this systematic review and meta-analysis was approved by the Helsinki and Uusimaa Hospital District Ethics Committee (HUS/1736/2018, 6 June 2018). Informed consent was obtained from all patients.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement Additional data are available in the publication of the BMJ Rapid Recommendations in MAGICapp and the parallel Cochrane Review. Extracted data are available in full from the authors upon request.

    • Patient consent for publication Obtained.