This Finnish FIMPACT trial is a multicentre, double-blind, placebo surgery controlled RCT in shoulder impingement syndrome. It compares arthroscopic subacromial decompression against diagnostic arthroscopy (sham surgery) and against exercise therapy. The key question: does removing acromial bone actually help, or is the benefit just the placebo of surgery?
When a patient with classic impingement pain asks whether decompression will fix them, this trial says the operation itself adds nothing over looking inside the joint. Both surgical groups improved by 30 to 55 VAS points, but the difference between real and sham surgery was tiny and statistically null. The benefit patients feel is placebo plus natural history, not acromial bone removal.
The design is the teaching point: without a sham surgical arm, you cannot separate the mechanical effect of an operation from the powerful placebo effect of undergoing surgery. This is why earlier unblinded trials misleadingly favoured ASD. The FIMPACT and concurrent CSAW trials together form the evidence base that shifted guidelines away from routine subacromial decompression.
Practically: treat impingement with a supervised exercise program first, and do not promise that decompression will outperform it.
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This Finnish FIMPACT trial is a multicentre, double-blind, placebo surgery controlled RCT in shoulder impingement syndrome. It compares arthroscopic subacromial decompression against diagnostic arthroscopy (sham surgery) and against exercise therapy. The key question: does removing acromial bone actually help, or is the benefit just the placebo of surgery?
When a patient with classic impingement pain asks whether decompression will fix them, this trial says the operation itself adds nothing over looking inside the joint. Both surgical groups improved by 30 to 55 VAS points, but the difference between real and sham surgery was tiny and statistically null. The benefit patients feel is placebo plus natural history, not acromial bone removal.
The design is the teaching point: without a sham surgical arm, you cannot separate the mechanical effect of an operation from the powerful placebo effect of undergoing surgery. This is why earlier unblinded trials misleadingly favoured ASD. The FIMPACT and concurrent CSAW trials together form the evidence base that shifted guidelines away from routine subacromial decompression.
Practically: treat impingement with a supervised exercise program first, and do not promise that decompression will outperform it.