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Shoulder Surgery for Subacromial Pain Syndrome (SAPS) - What is the evidence?

Shoulder injuries can be the most debilitating injuries due to the impact it can have on our day to day activities. Every year, in the UK, 1 in 50 adults report a new onset of shoulder pain and subacromial pain syndrome (SAPS) – previously known as shoulder impingement or rotator cuff disease is considered the most common.

Historically, surgeons suggested this injury arises from the “impingement” of the rotator cuff (muscles in the shoulder) between the head of the humerus on the underside of the acromion process (the area at the front of the shoulder at the later most part of the collar bone). As a result, surgeons developed a surgical technique called a Subacromial Decompression. Over the last 20 years surgery for SAPS has increased five-fold and the UK reports over 21,000 subacromial decompression's every year.

Tuomas Lahdeoja and his colleagues completed a study in 2019 to determine the benefits/harm of a subacromial decompression surgery for patients with subacromial pain syndrome. They discovered NO benefits of the surgery on the reduction of pain, improvements in movement and improvements in physical function when compared to a placebo surgery and non-conservative management such as specific exercises, advice, education and activity modification.

On average, patients reported a reduction of pain and improvement in symptoms regardless of surgery or non-surgical management. This leads us to begin questioning the need for this type of surgery and certainly should not be considered to be the first line of defence for this particular type of injury, especially when considering the risk/harm it could cause, when compared to alternative management options. Unfortunately, despite the clinical evidence, surgical numbers are continuing to rise, and, in many cases, patients have failed to complete any appropriate non-surgical management first.

More beneficial management of this type of condition should opt for early intervention, appropriate diagnosis, education, advice and exercise management as a priority with appropriate guidance and coaching on progression of exercises with a goal setting approach to help the individual achieve their desired outcomes. Although, this may be a considered to be a longer and less dramatic road to recovery, all the evidence is pointing towards this fast becoming the gold standard management for subacromial pain syndrome (SAPS).

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