A shoulder arthroscopic decompression or acromioplasty is a very common operation for people with severe shoulder pain, which is typically caused by rotator cuff or shoulder impingement. However, a recent British study has questioned the frequency of this procedure and its benefit.
Shoulder impingement syndrome, often referred to as shoulder bursitis, tendonitis impingement, swimmer’s shoulder, tennis shoulder, or thrower’s shoulder, is a condition caused by irritation or inflammation of the tendons attached to the rotator cuff muscles. It occurs when the tendons or bursa in the shoulder are caught between the tip of the acromion bone and the humerus bone, usually as a result of bone spurs.
Shoulder arthroscopic decompression has become a very frequent procedure and the recent study, in the Lancet journal, evaluated the efficacy of that operation. Their conclusion was that the shoulder arthroscopic decompression coupled with a physical therapy program provided greater pain relief than physical therapy alone, but the investigators did not consider the improvement to be significant.
Critics of the study have pointed out that the surgical patient group that failed a long course of conservative measures are a highly symptomatic group of patients with, most likely, more severe disease. The non-surgical patient group would, inevitably, have less severe disease, and thus, they improved without surgery. Others have mentioned the need for a larger sample size of patients before any conclusions can be drawn from the study.
So, what should you do if your orthopedic surgeon recommends arthroscopic decompression or acromioplasty?
Well, first, have you undergone any testing such as an MRI or X-Ray? Often, there are other causes of pain in addition to the impingement. For example, a rotator cuff tear may have developed from the bone spur scraping the tendons.
Next, have you had any conservative treatment? If you do not have a tear, then physical therapy can alleviate the pain in most cases.
Have you had a cortisone injection? This is, very commonly, the subsequent option if physical therapy has not eliminated the pain. Although it is often temporary, a cortisone injection can provide significant relief from pain.
If your pain still has not resolved and you want to try an alternative treatment, then options such as PRP (Plasma Rich Protein) or stem cell therapy exist — but there is no definitive evidence that these are an effective treatment for shoulder impingement.
Lastly, if all these conservative treatments fail, then there is simply no other proven effective option besides an arthroscopic shoulder decompression or acromioplasty.
In my experience, this is an extremely effective operation, but it is only appropriate in the right circumstances. It’s like the old saying goes; “You can use a cannon to kill a mouse,” but I say it’s better to save the cannon for the bigger problems.
