This has been a bad decade for orthopedic surgery. Heck, it’s been a bad two decades. Why? Study after study shows that these invasive procedures are often no better than fake or sham procedures in helping patients reduce pain and increase function. The latest entry in that now long list is shoulder decompression surgery.
Defining Subacromial Pain and Decompression Surgery
If you run your fingers along the top of your shoulder, when you are nearing the outer edge, you’ll feel a subtle prominence in the bone—this is your acromion process. In subacromial pain syndrome (aka shoulder impingement), the idea is that the rotator cuff tendons in the shoulder become impinged between the humerus (upper-arm bone) and the underside of the acromion process where bone spurs may have formed (often to protect the shoulder from instability). This results in chronic shoulder pain, and when conservative measures, such as physical therapy, or pain-relieving efforts, such as NSAIDs or steroid injections, fail, subacromial decompression surgery is often the next recommendation.
Subacromial decompression (aka shoulder decompression or acromioplasty) is a very common arthroscopic shoulder surgery that involves cutting out the bursa (the friction-reducing, lubricating sac of fluid between the rotator cuff tendons and the acromion bone) as well as removing the acromion joint and cutting away ligaments to eliminate rotator cuff impingement.
What We Already Know About Shoulder Decompression Surgery
All of this makes common sense from what we know in our mechanical world. If something is rubbing on something else, you cut out the offending part and it no longer rubs. However, the body is neurochemical mechanical. Meaning that addressing just the mechanics often doesn’t work. This is why we see orthopedic surgery procedures failing left and right in high-level research studies. This is a 1980s approach to the body that was never close to accurate.
We’ve already added shoulder decompression surgery to our growing list of rest-in-peace surgeries, alongside, for example, cervical disc replacement and fusion, hip impingement surgery, and knee replacement. We already know that the ligaments in this area of the shoulder are major stabilizers, and cutting them away introduces more instability to the shoulder. We also know that when there are tears in the rotator cuff and surgery includes “repairing” these, pain often still continues. To learn more about what the research says for bigger shoulder decompression surgery as well as view images of a shoulder that has undergone this surgery, watch my video below:
Now, this new shoulder study continues to confirm what we already know: removing critical shoulder structures creates instability and more trauma to the joint, and it simply isn’t effective and is, in fact, no better than a sham surgery. Let’s review…
Nothing Good Can Come from Shoulder Decompression Surgery
Not only can nothing good come from shoulder decompression surgery, but according to the newest study, it may even create more damage in the process.
In the new study, participants with shoulder impingement were blindly and randomly placed into one of two groups: shoulder decompression surgery or placebo surgery (fake surgery in which only the approach was performed but not the decompression). Researchers followed patients up to two years post surgery and determined the following results in the shoulder decompression group:
- A “high certainty” of no benefits to pain over the placebo group
- A “high certainty” of no benefits to function over the placebo group
- A “moderate certainty” of no benefits to quality of life over the placebo group
- A “moderate certainty” of complications (6 complications per 1,000 patients) following shoulder decompression
In other words, not only were pain, function, and quality of life no better in the shoulder decompression group when compared to the sham surgery group, but there was a greater risk of complications (e.g., frozen shoulder) following the shoulder decompression. Improved pain and function are the primary reasons patients give for undergoing shoulder decompression in the first place, and yet another study reveals the surgery simply isn’t providing these outcomes.
One Surgeon’s Response?
I actually spoke to a local surgeon about this study who claimed that he hadn’t performed this procedure in years. That’s great, but why then do I still see the walking wounded coming into my office having had shoulder decompression surgery who now have a grossly unstable shoulder? Meaning that someone is still doing these procedures. So be an educated consumer, and understand exactly what surgery is planned for your shoulder.
Interventional Orthopedics for the Shoulder
Thanks to interventional orthopedics solutions, shoulder surgery, such as shoulder decompression, can usually be avoided for most conditions, including shoulder impingement and instability. Watch Dr. Schultz below as he performs treatments to many areas of the shoulder using advanced and highly precise image-guided injections of orthobiologics:
The upshot? We desperately need many more placebo or sham-controlled trials on many common orthopedic surgeries. My guess is that most of them, in the end, will be shown to be ineffective because they conceptualize what’s wrong in the wrong way. Meaning, these are 1980s structural procedures that now live in a world where we know that the body is far more complex than its structure.