ARTHROSCOPIC SUBACROMIAL DECOMPRESSION FOR SUBACROMIAL SHOULDER PAIN (CSAW): A MULTICENTRE, PRAGMATIC, PARALLEL GROUP, PLACEBO-CONTROLLED, THREE-GROUP, RANDOMIZED SURGICAL TRIAL

Review written by Simon Kirkegaard info

BACKGROUND & OBJECTIVE

Shoulder pain is a major socioeconomic problem worldwide and accounts for as many as 4-5 million visits to the physician in the USA. A structural mechanism has been proposed for shoulder pain, where the rotator cuff is impinged in the space between the head of the humerus and the bottom of acromion. Shoulder decompression was introduced without high-level evidence in 1972, as a mean to increase the space and resolve the pain problem. Today, shoulder decompression is one of the most common surgical procedures despite the lack of high level evidence. Therefore, the aims of this study were to compare decompression surgery to arthroscopy only to no treatment.

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METHODS

313 participants were recruited from 30 different sites and were randomly allocated to surgical subacromial decompression or investigative arthroscopy only groups or to a no treatment group. The operations were managed by 38 surgeons. Participants undertaking surgery were not informed which surgical intervention they had undergone to use the arthroscopy group to elucidate the placebo effect of the surgical intervention. Only the participants undergoing surgery received postoperative care and exercise therapy. Patients included had to have subacromial pain for more than 3 months, completed a non-operative management program which included exercise therapy and at least one steroid injection, have intact rotator cuff tendons and be eligible for arthroscopic surgery. Participants with full-thickness tears were excluded. All assessment was blinded.

RESULTS

The Oxford Shoulder Score, a patient-reported questionnaire, was used as primary measure and is an effective tool to identify change in function and pain in shoulders over time. Measures were taken at baseline, 6 months and 12 months. All three

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