This is a multicentre, double-blind, placebo surgery controlled randomised trial of arthroscopic subacromial decompression (ASD) for shoulder impingement. It asks whether ASD outperforms sham surgery (diagnostic arthroscopy) and exercise therapy at 5 years. 210 patients aged 35–65 with impingement symptoms over 3 months were followed for 5 years.
When a patient with atraumatic subacromial pain and a positive painful arc asks about surgery, this trial gives you the number to counsel with: ASD is no better than placebo at 5 years. The design is the strength here. By using diagnostic arthroscopy as a sham arm, the authors isolated the bony decompression as the only variable and controlled for the profound placebo effect of surgery itself.
The lesson is that improvement in impingement patients reflects natural history and nonspecific effects, not correction of a mechanical spur. This is why exercise therapy performed just as well.
One pitfall to avoid on boards and in clinic: a statistically significant secondary outcome (the 7.1-point Constant-Murley) that fails to cross its MID of 17 is not a clinical win. The authors attribute it to chance across multiple comparisons. The authors go further, recommending we abandon the mechanical term impingement in favor of subacromial pain.
Subacromial Decompression versus Diagnostic Arthroscopy for Shoulder Impingement: a 5-Year Follow-Up of a Randomised, Placebo Surgery Controlled Clinical Trial.
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A System for the Functional Evaluation of Reconstructive Procedures after Surgical Treatment of Tumors of the Musculoskeletal System.
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Clinician's Guide to Prevention and Treatment of Osteoporosis.
Prevention of Venous Thromboembolism
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Epidemiology of Adult Fractures: a Review.
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Metastasis to Bone: Causes, Consequences and Therapeutic Opportunities.
Role of Proinflammatory Cytokines in the Pathophysiology of Osteoarthritis.
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This is a multicentre, double-blind, placebo surgery controlled randomised trial of arthroscopic subacromial decompression (ASD) for shoulder impingement. It asks whether ASD outperforms sham surgery (diagnostic arthroscopy) and exercise therapy at 5 years. 210 patients aged 35–65 with impingement symptoms over 3 months were followed for 5 years.
When a patient with atraumatic subacromial pain and a positive painful arc asks about surgery, this trial gives you the number to counsel with: ASD is no better than placebo at 5 years. The design is the strength here. By using diagnostic arthroscopy as a sham arm, the authors isolated the bony decompression as the only variable and controlled for the profound placebo effect of surgery itself.
The lesson is that improvement in impingement patients reflects natural history and nonspecific effects, not correction of a mechanical spur. This is why exercise therapy performed just as well.
One pitfall to avoid on boards and in clinic: a statistically significant secondary outcome (the 7.1-point Constant-Murley) that fails to cross its MID of 17 is not a clinical win. The authors attribute it to chance across multiple comparisons. The authors go further, recommending we abandon the mechanical term impingement in favor of subacromial pain.