Shoulder pain surgery: one popular procedure not backed by evidence

This article comments on recent randomised control trials in both the UK and Finland that both demonstrate that a common operation for shoulder pain, known as a sub-acromial impingement. This surgery aimed to “shave the bone” at the tip of the shoulder to open up space and stop the rotator cuff (specifically the supraspinatus muscle and bursa) from being impinged or pinched. However this has little effect on shoulder pain.

Shoulder pain is very common as the shoulder is very dynamic or active, with many parts that need to work properly for the shoulder to work effectively.    This includes:

  • Good shoulder blade control.
  • Upright mid back posture.
  • Sound rotator cuff muscle control (the muscles that sit on the shoulder and attach directly onto the shoulder).
  • Regular capsule tightness (not too tight and not too loose) around the shoulder.
  • Normal and not inflamed bursa around the tip of the shoulder.

Bony spurs over the tip of the shoulder (on the acromion) rarely actually cause direct pain in the shoulder and all the other factors need to be addressed first before deciding that the spurs are the potential cause of symptoms.

Surgery (such as a repair of the rotator cuff muscles) may be needed, if there is a new tear of this muscle that is moderate to large AND you are relatively young and sporty.  In most other cases, exercise and strengthening are main forms of treatment that work on this issue.

Any of our Physiotherapy or Exercise Physiology staff at MD Health will be able to assist if you have any questions about what is the right approach for you.

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Shoulder pain surgery: one popular procedure not backed by evidence

Many countries have strict regulations to ensure new drugs are effective and are worth the money before doctors can prescribe them. But surgical procedures are often less strictly regulated. This can lead to people having risky surgery even though there is no clear evidence that it works. One such surgery is called subacromial decompression – one of the most common procedures to treat chronic shoulder pain.

Author: Michael Dermansky

Michael has now been working in physiotherapy for over 20 years, since graduating from Melbourne University in 1998 and is even more passionate about getting the best outcomes for clients than he was then. Michael is always studying and looking for new and innovative ways to improve the service at MD Health, including and not limited to the ideas from the fitness industry and great customer service companies. In his spare moments, he loves spending time with his two children, Sebastian and Alexander and hopefully taking them skiing more and more often.

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