Experts advise against surgery for shoulder pain

Surgery for shoulder pain that is not caused by injury has no better results than nonsurgical options or placebo surgery, and that it has effects harmful potential, concluded a panel of experts.
The international panel of clinicians, researchers, and patients focused on what is called rotator cuff disease, as opposed to rotator cuff lesions that tear the tendon of the joint, which may require surgery.
Their recommendations are based on two systematic evidence reviews including seven randomized controlled trials involving 1,014 patients, one focusing on the pros and cons of so-called decompression surgery for rotator cuff disease and stroke. 39, another on the point of whether the operation produced significant improvements in pain, movement and quality of life.
The most likely cause is degeneration of the rotator cuff tendon in people with shoulder pain, said lead author of the study, Dr. Rudolf Poolman, researcher in orthopedic surgery at the department of surgery orthopedic clinic of OLVG in Amsterdam.
"In fact, there is no real proof that surgery is beneficial for any type of tendinopathy in the human body," Poolman said in an email. "The shoulder pain is multifactorial and it is also very important to take into account factors not related to the shoulder – such as psychological and social factors -."
When Poolman and his colleagues badyzed the evidence, they found that after a year there was little difference between operated patients and those who did not have it. For example, on a pain scale of 1 to 10, with 10 being the most severe pain, the average pain score in operated patients was 2.6, compared to 2.9 for those who did not have pain. not undergone surgery.
To evaluate the return of the function on a scale of 1 to 100, 100 being the best function, the operated patients evaluated their function at 72 on average, while those who had not undergone surgery evaluated it at 69. .
The committee's decision was also taken into account the risk of adverse side effects of surgery. These included death, infections, blood clots, problems related to anesthesia and a condition called frozen shoulder.
The best management for patients is a combination of physical therapy, exercise programs, anti-inflammatory medications and steroid injections, writes the group of experts in The BMJ.
"The pain in the shoulder can be unbearable and the patients need support and compbadion," Poolman said. "The evidence shows that surgery works as well as placebo surgery or physiotherapy. Surgeons must be aware of this and rebadure the patient that the pain will one day lessen and that the surgery has potential side effects that can worsen the situation. "
The new guideline attempts to "determine what needs to be done for people who have rotator cuff tendon irritation, which carries many different names, including rotator cuff disease, or rotator cuff syndrome." subacromial pain and yoke on the shoulder, "said Dr. Edward. McFarland, professor of orthopedic surgery and shoulder Wayne H Lewis and director of shoulder surgery at Johns Hopkins University in Baltimore.
"The tendon degenerates with age. We do not know exactly why this happens, but all body tendons weaken as we get older, "said McFarland, who did not participate in the panel of recommendations.
He suspects that the positive results obtained by patients with the decompression procedure could be due at least in part to the requirement of resting the joint after surgery.
The new guide could not only discourage doctors from offering surgery, but also make reimbursement less likely by insurance companies, said Dr. Charles Jobin, orthopedic surgeon and badistant professor of orthopedic surgery at New York-Presbyterian / Columbia University at Irving Medical Center in New York City of York.
And even if patients want to achieve faster results than with non-surgical treatment, they need to be informed of the potential disadvantages of a shoulder intervention, "said Jobin, who does not say anything about it. also did not participate in the panel.
Regional anesthesia used during the procedure could also cause injuries, said Jobin. "About one in 10,000 or 100,000 is left with a nerve injury or a problem. It's extremely rare, but when that happens, it can be devastating. You arrive because of a sore shoulder and you end up with a weak arm, a numb thumb or a pain in the arm that does not go away. "