Intended for healthcare professionals


Subacromial decompression surgery for shoulder pain

BMJ 2019; 364 doi: (Published 07 February 2019) Cite this as: BMJ 2019;364:l586

Linked Practice

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

  1. Nick A Aresti, ST8 trauma & orthopaedic surgery1,
  2. Livio Di Mascio, consultant upper limb surgeon2
  1. 1Percivall Pott Rotation, London, UK
  2. 2Barts Health NHS Trust, London
  1. Correspondence to: N Aresti email{at}

Approach with caution

We read the linked BMJ Rapid Recommendation by Vandvik and colleagues1 with interest. The benefit of arthroscopic subacromial decompressions (ASD) for shoulder impingement has divided opinion among healthcare professionals for years. Despite good evidence against its efficacy, including a BMJ study by Brox and colleagues in 1993, which showed no difference between ASD and an exercise programme,2 its use has increased dramatically over the past quarter of a century. The past decade alone saw an increase of 746% in the number of procedures across the UK.3

Several high profile papers have recently been published questioning the efficacy of ASD. These include the Oxford based CSAW study,4 the Finish FIMPACT trial,5 and a series of systematic reviews.67 These studies show a statistically significant difference in shoulder scores between patients treated surgically (with ASD or control arthroscopy) and patients treated …

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