Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(5):30 Br J Sports Med. 2021 Jan;55(2):99-107.What this means for my practice?
Arthroscopic subacromial decompression does not offer any meaningful long-term benefit over diagnostic arthroscopy or structured exercise therapy for shoulder impingement syndrome. Clinicians should consider these findings when recommending surgery for patients with subacromial pain. A key limitation of the study is the possibility of placebo effects influencing outcomes in both surgical groups, though the rigorous design minimizes bias.
Study Summary
Two hundred ten patients with shoulder impingement syndrome were randomized to receive either arthroscopic subacromial decompression (ASD) (n=59), diagnostic arthroscopy (n=63), or exercise therapy (n=71). The primary outcomes of interest were shoulder pain at rest and on arm activity, measured using a Visual Analogue Scale (VAS). Secondary outcomes included Constant-Murley score, Simple Shoulder Test score, SF-36, and 15D health-related quality of life measures. Outcomes were assessed over five years. Overall, the results of the study revealed no clinically significant differences between ASD and diagnostic arthroscopy, nor between ASD and exercise therapy, in reducing shoulder pain or improving function. The study suggests that ASD does not provide additional benefits over diagnostic arthroscopy or structured exercise therapy in the long term.
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