Subacromial decompression surgery for adults with shoulder pain : a clinical practice guideline

Show full item record



Vandvik , P O , Lähdeoja , T , Ardern , C , Buchbinder , R , Moro , J , Brox , J I , Burgers , J , Hao , Q , Karjalainen , T , van den Bekerom , M , Noorduyn , J , Lytvyn , L , Siemieniuk , R A C , Albin , A , Shunjie , S C , Fisch , F , Proulx , L , Guyatt , G , Agoritsas , T & Poolman , R W 2019 , ' Subacromial decompression surgery for adults with shoulder pain : a clinical practice guideline ' , BMJ : British Medical Journal , vol. 364 , 294 .

Title: Subacromial decompression surgery for adults with shoulder pain : a clinical practice guideline
Author: Vandvik, Per Olav; Lähdeoja, Tuomas; Ardern, Clare; Buchbinder, Rachelle; Moro, Jaydeep; Brox, Jens Ivar; Burgers, Jako; Hao, Qiukui; Karjalainen, Teemu; van den Bekerom, Michel; Noorduyn, Julia; Lytvyn, Lyubov; Siemieniuk, Reed A. C.; Albin, Alexandra; Shunjie, Sean Chua; Fisch, Florian; Proulx, Laurie; Guyatt, Gordon; Agoritsas, Thomas; Poolman, Rudolf W.
Contributor organization: I kirurgian klinikka (Töölö)
University of Helsinki
Department of Surgery
HUS Musculoskeletal and Plastic Surgery
Date: 2019-02-06
Language: eng
Number of pages: 8
Belongs to series: BMJ : British Medical Journal
ISSN: 1756-1833
Abstract: Clinical question Do adults with atraumatic shoulder pain for more than 3 months diagnosed as subacromial pain syndrome (SAPS), also labelled as rotator cuff disease, benefit from subacromial decompression surgery? This guideline builds on to two recent high quality trials of shoulder surgery. Current practice SAPS is the common diagnosis for shoulder pain with several first line treatment options, including analgesia, exercises, and injections. Surgeons frequently perform arthroscopic subacromial decompression for prolonged symptoms, with guidelines providing conflicting recommendations. Recommendation The guideline panel makes a strong recommendation against surgery. How this guideline was created A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines and the GRADE system. The recommendation is based on two linked systematic reviews on (a) the benefits and harms of subacromial decompression surgery and (b) the minimally important differences for patient reported outcome measures. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of surgery in multilayered evidence summaries and decision aids available in MAGIC ( to support shared decisions and adaptation. The evidence Surgery did not provide important improvements in pain, function, or quality of life compared with placebo surgery or other options. Frozen shoulder may be more common with surgery. Understanding the recommendation The panel concluded that almost all informed patients would choose to avoid surgery because there is no benefit but there are harms and it is burdensome. Subacromial decompression surgery should not be offered to patients with SAPS. However, there is substantial uncertainty in what alternative treatment is best.
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: publishedVersion

Files in this item

Total number of downloads: Loading...

Files Size Format View
bmj.l294.full.pdf 352.5Kb PDF View/Open

This item appears in the following Collection(s)

Show full item record