Does Shoulder Decompression Surgery Really Work?

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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.

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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.

The Problem with SAPS Surgery

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.

The Role of Physical Therapy

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.

SAPS Treatment in NYC

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.

Source

Lähdeoja T, et al., (2019). Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis. Br J Sports Med, bjsports-2018.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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