Guidelines Recommend Against Surgery for Subacromial Pain Syndrome

Subacromial decompression surgery should not be offered to patients with subacromial pain syndrome, according to a new guideline from The BMJ’s Rapid Recommendations panel. The guidance — considered a strong recommendation — applies to patients with atraumatic shoulder pain, including rotator cuff disease, lasting longer than 3 months.

The recommendation was based on findings from seven randomized trials among roughly 1000 patients that compared decompression surgery with either sham surgery or exercise alone. Overall, decompression surgery did not provide a meaningful benefit over nonsurgical treatment in terms of pain, function, or quality-of-life. However, surgery was associated with more cases of frozen shoulder (12 more cases per 1000 patients undergoing surgery) and could cause more serious adverse events like major bleeding.

The panel, which included patients, clinicians, and researchers, concluded: “Almost all informed patients would choose to avoid surgery…. However, there is substantial uncertainty in what alternative treatment is best.”