RIP Shoulder Decompression Surgery: Another Common Orthopedic Surgery Bites the Dust

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shoulder decompression surgery research

The orthopedic-surgery research this past decade has been like the Queen song “Another One Bites the Dust.” It seems like every month another randomized controlled trial shows that the common orthopedic procedures that patients sign up for every day fare no better than fake or placebo procedures. The most recent entry is shoulder decompression surgery.

What Is Shoulder Decompression Surgery and Why Is It Done?

The idea behind shoulder decompression surgery is that the rotator cuff and its lubricating bursa can become “impinged” by bone spurs and that we need to release the pressure by cutting away ligaments and bone spurs. This extra space will allow the rotator cuff to function better. The idea seems simple, which is likely why the procedure has become so popular.

However, there are problems with the simplicity of this explanation. First, the ligaments that are cut are major stabilizers of the shoulder, so cutting them creates shoulder instability. This means that over time, the shoulder rotator cuff and joints will experience more and not less trauma. In addition, research has shown that rotator cuff tears and their healing after surgery doesn’t correlate well with less pain. In fact, it’s the chemical environment in the shoulder joint that correlates better with pain levels. Hence, the focus here on fixing the shoulder structure with surgery may be a misplaced concept from the start.

Prior Shoulder Decompression Research

I have blogged on a past study that demonstrated that a shoulder decompression surgery wasn’t effective. At the time, many surgeons complained that the images I used for the video on the study were from an outdated and rarely used larger decompression procedure. Despite that, I still see patients who get this bigger procedure. Be that as it may, today’s study is on the more common decompression procedure performed tens of thousands of times a year in the U.S.

The New Shoulder Decompression Research

The new research was massive, involving 32 hospitals, 51 surgeons, and more than 300 patients in the UK. The patients were randomized to either surgical decompression, arthroscopy only (placebo surgery where nothing was done), or no treatment.  The results? The surgery groups did slightly better, but those differences weren’t clinically important. In addition, the decompression group did no better than the sham surgery group. In the end, the conclusion was that shoulder decompression surgery is no better than placebo.

Another One Bites the Dust…

“Out of the doorway, the bullets rip, to the sound of the beat, another one bites the dust. Another one bites the dust. And another one gone, and another one gone, another one bites the dust…”

I was keeping track of the percentage of common orthopedic surgeries (costing many billions annually and harming thousands of patients through complications) that have been shown to be no better than placebo or physical therapy. By my back-of-the-napkin calculations, we’re up to about 60% of all elective orthopedic surgeries being useless. How long will it be before US insurers stop covering these invasive, no-better-than-placebo surgeries? I suspect that national healthcare systems, like the NHS, will be the first to eliminate them. In the U.S., so many big players will lose so much money, that I suspect that they’ll be around for a longer time. For example, we have hospitals that wouldn’t be able to make payroll or pay the light bill if they eliminated 60% of elective orthopedic procedures. We have medical-device companies that would declare bankruptcy and lay off armies of surgical-sales reps. Finally, many orthopedic practices would go out of business.

The upshot? Yet another one bites the bust! I suspect that once all of the research now in process is done that 80% of elective orthopedic procedures for pain will be found to be useless. Given that we’re up to about 60% now, we don’t have far to go. We are literally witnessing a historic event: the research base that has supported an entire dominant field of medicine is literally falling apart. Is it time for orthopedic surgery to get a reboot and be reborn as interventional orthopedics?

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12 thoughts on “RIP Shoulder Decompression Surgery: Another Common Orthopedic Surgery Bites the Dust

  1. Tommy Solberg

    About time. I opted a couple of years ago. Went with PRP instead. Everybody doing fine!

    1. Regenexx Team Post author

      Tommy,
      Great choice – great news!

  2. DavePG

    Is there a list or link to a catalog of these useless elective orthopedic surgeries? This would be a handy reference for laymen such as myself to have that we can refer to if needed (and a lot easier than searching and trying to interpret PubMed studies). Thanks.

    1. Regenexx Team Post author

      Dave PG,
      We put together a list a while back. Please see: https://regenexx.com/blog/useless-orthopedic-surgery/

  3. Anthony Wiertel

    I hope that some time soon, the same can be said for knee replacement surgery. I’m bone on bone in both knees and have been recommended by an ortrhopaedic surgeon for a double knee replacement. The prospect doesn’t thrill me. I’ve been reading up on stem cell therapy, platelet rich plasma, amniotic fluid therapy, etc. and am hoping this will someday soon serve as a viable long term solution to knee replacement surgery.

    1. Regenexx Team Post author

      Anthony,
      It has been! Please see: https://regenexx.com/blog/knee-replacements-not-performed-younger-patients/ Alternatives to knee replacement are incredibly important, as aside from the risk and complication profile, they are irreversible. Of the three therapies you mentioned looking into, only stem cells, which neither PRP nor Amniotic Fluid contain, would be an appropriate treatment for severe (bone on bone) knee arthritis. Please see: https://regenexx.com/blog/getting-a-golfer-back-on-the-links-with-knee-stem-cells/ and https://regenexx.com/the-regenexx-procedures/knee-surgery-alternative/ and https://regenexx.com/blog/knee-replacement-after-stem-cell-treatment/ It’s also very important to get a thorough back exam before considering knee replacement: Please see: https://regenexx.com/blog/low-back-and-knee-pain/ and https://regenexx.com/blog/knee-replacement-outcomes-back-pain/

  4. Richard C Sweeting

    Perhaps the cause of shoulder impingement may well be defective neuromuscular control of elevation. This action requires a complex interplay of the subscapularis and infraspinatus muscles to maintain centralization of the humeral head in the glenoid as the deltoid elevates the arm which, at the same time, would otherwise tend to displace the humeral head superiorly. These patients have a type of weakness in the infraspinatus initially called pseudoparesis by Vladimir Janda (a Czech physiatrist) in the 1970s — to avoid confusion with pain inhibition the joint and bursa should be anaesthetized. These patients will also show this ‘giving way’ type of weakness with repeated stress testing of the ipsilateral forearm pronators. However this is not merely a ‘false weakness’ but a true dysfunction likely due overriding or failure of the ‘ Load Compensation Reflex’.or alternatively premature stimulation of the ‘Load Protection Reflex’.

  5. S B

    The article you cited said they severed the CA ligament, and it was optional. It isn’t a crucial ligament, really. It prevents the humeral head from popping out of the socket in the event of a weird dislocation and provides a slight amount of stability. Other than that, it’s a static ligament, not a dynamic one. I had a subacromial decompression w/o CA severing and a distal clavicle excision to treat a chronic grade 2 AC separation that I never got treated or rested after the acute injury. Which, by the way, are not proper treatments in my opinion. But Mumfords and decompressions are still commonly practiced. I struggle with chronic subacromial impingement that started 15 years ago to this day after the initial separation. It sucks. You’d think if you are shaving away perfectly healthy bone under the acromion and from the end of the clasvicle, you might want to be sure they’re causes, not symptoms. Sometimes, I hate orthopedists, and doctors. They made me a statistic.

    1. Regenexx Team Post author

      SB,
      Actual diagnosis by exam is missing from Orthopedics and without determining what has caused the problem, you’re unlikely to be in a position to solve it. Please see:
      https://regenexx.com/blog/modern-orthopedic-surgery-for-pain/

      1. SB

        I assume by “actual” you mean “accurate”. There is a problem I have with the article you cited. You also sound like a salesman trying to sell me something. You make it sound like Orthopedists in general are incompetent. Whom are patients to believe? 99% of the time we’re uneducated on this stuff and don’t have a clue what any of you are talking about. So we put our lives in your hands. What I think is lacking is a backup contingent from ALL Orthos in the event something goes awry. Not just telling us there’s a risk this might not work and you’re screwed.

        For instance, in my situation, what could Regenexx offer, to really to fix my root problem? Nothing. Unless you can manipulate anatomy at will. The useful niche I’d see for this product is in accelerating healing after interventional surgery. And even then, do you guarantee a solid heal? If you apply this stuff to torn ligaments/bone, you still need a scaffold/bridge for these compounds to cure. Injecting this stuff into the AC joint of a Grade 5 separation won’t do anything because the severed ligaments are unmended. I assume many interventional surgeries are still efficacious and you could still use in conjunction to shorten recovery times. You could also work to treat people within the precious 3 week healing window for torn ligaments.<-This in itself seems to present another hurdle because I've never been able to get an appt. with a surgeon within a month's time. But your points are still valid in that a number of surgeries don't work. Razing the problem can cause two more problems. Excisions really are the opposite of regenerative therapy.

        1. Regenexx Team Post author

          SB,
          We see patients regularly who have been left dealing with issues resulting from surgeries, many of which were not needed in the first place as surgical decisions today are often made based on X-ray or MRI and a cursory exam. Actual diagnosis requires much more than that as it takes time to investigate and understand what’s actually going on, what’s caused it, and what it is affecting. The point of Interventional Orthopedics is to avoid surgery as all surgery is damage to accomplish a goal. The Candidacy process is designed to identify what is and isn’t within treatment range. Stem cells are not magic, but you may be surprised what no longer requires surgery. Please see: https://regenexx.com/blog/avoid-rotator-cuff-surgery-2/ and https://regenexx.com/blog/surgery-controlled-damage-accomplish-goal/ and https://regenexx.com/blog/shoulder-labral-tear-surgery-pros-cons/ and https://regenexx.com/blog/watch-advanced-image-guided-injection-shoulder-step-procedure-suite-dr-schultz/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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