BMJ Rapid Recommendation: Strong against shoulder decompression surgery

A dear child has many names: subacromial pain syndrome, rotator cuff disease, shoulder impingement, painful arc – all labels for the most common shoulder pain diagnosis. For more than 50 years it has been treated with acromioplasty or subacromial decompression surgery. At first, acromioplasties were carried out as open surgical procedures, but with the advent of arthroscopic techniques, the enthusiasm of the surgeons just exploded during the past few decades. At best, we were witnessing some 8,000 such surgeries per year in Finland and +20,000 in the UK.

The only problem, from the EBM point of view: There has never been a single trial to support the practice!

Publication of our FIMPACT trial acted as a trigger for the BMJ to gather a Rapid Recommendation panel to formulate a clinical practice guideline on this topic. This guideline basis on evidence provided by a systematic review and meta-analysis led by FICEBO investigator Tuomas Lähdeoja. The systematic review, conducted synchronously with a Cochrane update and led by another FICEBO investigator Teemu Karjalainen, found that subacromial decompression surgery provides little or no benefits to patients in terms of shoulder pain and function, but is probably associated with rare serious harms.

The BMJ Rapid recommendation is a new initiative trying to facilitate transition of new evidence into practice through trustworthy recommendations given by a team of experts, methodologists and patients. It gave a strong recommendation against subacromial decompression surgery. We look forward to observing whether this guideline prompts a change in practice, eradication of useless and potentially harmful surgery, and as a result, improved patient care!