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The musculoskeletal and orthopaedic world has been challenged by a recent randomised controlled trial that compared surgical (arthroscopic) subacromial decompression (SAD) with placebo surgery or monitoring only for patients with ‘subacromial’ shoulder pain who had not responded to conservative care.1 At 6 and 12 months, both surgical groups reported better outcomes than monitoring only, but the difference was not clinically significant.
What now? What should we offer patients who have not responded sufficiently to non-surgical approaches? Here are some reflections on the implications of this game-changing trial.1
1. Stop using the term impingement
‘Subacromial’ shoulder pain has traditionally been understood from a specific structural perspective, that is, bony and soft-tissue structures under the acromion impinging on subacromial structures. These new findings challenge this dogma as the two groups that did not undergo SAD reported similar outcomes to the group that did. This means that ‘impingement’ does not adequately explain ‘subacromial’ pain and hence is …
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