Common NHS shoulder surgery no better than placebo at relieving pain

An increasingly popular form of shoulder surgery carried out on more than 21,000 people a year is almost entirely pointless, a major new study has found.

Decompression surgery, a keyhole procedure designed to remove small areas of bone and tissue around the joint, proved no better at relieving pain than a placebo in a trial across 32 hospitals.

Experts at Oxford University, who conducted the research, last night questioned why the operation had been allowed to become so commonplace despite no robust evidence supporting its use.

Meanwhile the Royal College of Surgeons, which partly funded the study, suggested the procedure should no longer be offered routinely on the NHS.

The authors demanded that doctors explain to their patients the lack of benefit before recommending the operation.

Shoulder pain accounts for more than one in 50 GP consultations in the UK and can have a devastating effect on people’s lives by making it difficult to work, drive or get dressed.

Subacromial decompression was first used in 1972, but since 2000 its use has increased more than sevenfold from 2,523 to 21,355 in 2010.

A trial of more than 300 patients, published in The Lancet, found that those who underwent the procedure enjoyed only a negligible, or “clinically insignificant”, improvement in pain after six and 12 months compared to those subjected to a mock procedure.

Scientists behind the study say the improvement in pain may be thanks to the postoperative physiotherapy undergone by both sets of patients, rather than the surgery.

Decompression patients scored an average 32.7 on the Oxford Shoulder Score compared to 34.2 among the placebo patients, with the higher score indicating less pain.

A third group who underwent no treatment at all had an average of 29.4, indicating that for many patients symptoms of a painful shoulder improve naturally over time.

Professor Andrew Carr, who co-led the investigation, said: “Over the past three decades, patients with this form of shoulder pain and clinicians have accepted this surgery in the belief that it provides reliable relief of symptoms, and has low risk of adverse events and complications.

“However, the findings from our study suggest that surgery might not provide a clinically significant benefit over no treatment, and that there is no benefit of decompression over placebo surgery.”

The rationale for the procedure, which is available on the NHS, is that pain is caused by physical contact during arm movement between the rotator cuff tendons and a spur of bone or soft tissue projecting from the shoulder blade.

Removal of the bone spur and soft tissue is supposed to reduce symptoms.

Side-effects are uncommon but include infection and venous thromboembolism, a clotting of blood in the vein.

According to the authors, this is the first study to compare the effects of the surgery to a placebo comparison, although they acknowledge that such trials across medicine are relatively rare.

“In light of our results, other ways to treat shoulder impingement could be considered, such as painkillers, physiotherapy and steroid injections.” says co-chief investigator Professor David Beard, also from Oxford.

Natalie Carter, head of research liaison and evaluation at Arthritis Research UK, which also partly funded the trial, said: “Often shoulder pain can be short-lived, but if you’re experiencing shoulder pain which continues for more than two weeks, or gets worse, speak to your doctor or a physiotherapist in case you have a more complex problem.”