Article Text

Download PDFPDF
How should clinicians integrate the findings of The Lancet’s 2018 placebo-controlled subacromial decompression trial into clinical practice?
  1. Chris Littlewood1,
  2. Julie Bury2,
  3. Aidan O’Shea3,
  4. Karen McCreesh4,
  5. Kieran O’Sullivan4,5
  1. 1 Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit, Keele University, Keele, UK
  2. 2 Physiotherapy Department, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
  3. 3 School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
  4. 4 Health Research Institute and School of Allied Health, University of Limerick, Limerick, Ireland
  5. 5 Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Dr Kieran O’Sullivan, Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar ; kieran.osullivan{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

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 …

View Full Text


  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.