Every year, thousands of patients seek treatment for debilitating shoulder pain that is not associated with injury or trauma. The pain may have a gradual or sudden onset, and can severely restrict shoulder range of motion. The most common diagnosis is subacromial pain syndrome (SAPS), also called shoulder impingement or rotator cuff disease.
Surgeons believe that SAPS is caused by impingement of the rotator cuff tendons between the head of the humerus, or upper arm bone, and the acromion process, where the shoulder blade meets the collar bone to form the acromioclavicular joint.
The common solution is subacromial decompression surgery, a procedure that entails the removal of the subacromial bursa and a portion of bone from the acromion to prevent rotator cuff impingement. SAPS surgery is often recommended when more conservative treatment like physical therapy fails to resolve the problem.
According to the British Journal of Sports Medicine, the incidence of SAPS surgery has increased by five times over the past two decades, leading researchers to question the procedure’s efficacy, and to establish guidelines for the medical community.
When adults experience pain that appears from out of nowhere, they typically consult their primary care provider, who then refers them to a specialist for further treatment. Unfortunately for the patient, the specialist is often a surgeon, and not a physical therapist.
Oftentimes, surgery becomes the first line of treatment for SAPS, when more conservative therapy may offer a less expensive, less invasive and less painful solution. Moreover, past research studies have failed to demonstrate that subacromial decompression surgery is more beneficial than exercise therapy for SAPS.
A new systematic review and meta-analysis (Lähdeoja, 2019) set out to explore the harms and benefits of subacromial decompression surgery in adult patients with SAPS lasting longer than three months.
Their findings revealed:
When compared with placebo (sham) surgery, subacromial decompression surgery provides NO additional benefits in terms of pain, function or quality of life in adults with SAPS, and may possibly cause harm.
Subacromial decompression surgery may provide a small amount of pain relief compared to exercise therapy, but may fail to improve shoulder function.
The role of subacromial decompression surgery should be reconsidered by patients, policy makers, and clinicians.
When chosen as a first line of treatment, physical therapy can often relieve and resolve SAPS and other conditions that are commonly — and often unnecessarily — treated with surgery. In fact, the current guidelines for SAPS recommends surgery only after other more conservative interventions have failed.
However, for physical therapy to be effective, certain conditions must be met:
Patient referral: While some primary care providers understand the value of physical therapy and prescribe it as a first line of treatment for musculoskeletal pain, others are quick to refer patients to a surgeon without considering conservative care.
Patient education: When faced with debilitating pain, patients often assume that surgery is the best and fastest solution. Patients deserve to be better informed of available treatment options before electing to undergo invasive and potentially harmful surgery.
Patient compliance: Physical therapy is only effective if exercises are done consistently and correctly. Patients who are unfamiliar with the benefits of physical exercise may fail to comply with the therapist’s recommendations, often skipping appointments and failing to do assigned homework.
Musculoskeletal pain like SAPS often arises from a variety of issues that are common among adults living in technologically advanced countries. Causes may include:
- Lack of physical activity
- Poor posture
- Muscle tightness and/or weakness
- Stress-induced muscle tension
- Repetitive overuse from everyday activities
Those issues can often be corrected and eradicated with physical therapy.
Daily lifestyle habit, excessive computer use and being sedentary are often the underlying causes of non-traumatic musculoskeletal pain. The shoulder pain specialists at NYDNRehab don’t stop at treating pain symptoms — we get to the source of pain and correct it, so you can enjoy an active and pain-free quality of life. If you are suffering from shoulder pain, contact us today, and see what a difference physical therapy can make.
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