Have you ever had so much pain in your shoulder that you assumed only surgery could fix it? Well, recent surprising evidence has found that some shoulder surgeries are less effective than we assumed. In fact, you might only get better because of a placebo effect, or from rehabilitation exercises!
The Can Shoulder Arthroscopy Work study was recently published in the very reputable medical journal, The Lancet. The design of the study was very pragmatic with large sample sizes and multi-centre locations. The surgeries were performed at various hospitals around the UK. The assumption for many years has been that "cleaning-out" or "decompressing" the shoulder joint with an arthroscopic surgery would lead to improved shoulder pain and function.
The procedure uses a long, telescopic looking technology called an arthroscope to peer into the shoulder joint and then shave away a portion of the acromion, pictured below. This increase in space would theoretically be both minimally invasive and maximally effective at improving function and outcomes.
While this approach intuitively makes sense, researchers have recently questioned these types of arthroscopic surgeries. And with good cause.
For example, knee arthroscopic surgeries were performed with a similar device, and for similar indications, for many years without testing. Researchers, clinicians and patients were surprised to learn that this surgical procedure in the knee joint was no more effective than if the surgeons simply pretended to do the surgery! This landmark study was published in the highly esteemed journal, The New England Journal of Medicine.
The implications of the recent CSAW study are written in the Lancet as follows:
Chiropractors, Physiotherapists and other conservative minded practitioners should be consulted if you are considering a shoulder surgery. What we have learned in the era of evidence based medicine is that many procedures, like surgery, may not always be the panacea that we would hope.
With your treatment, appropriate diagnosis, manual therapy and a decent program of exercise, stretching and advice may offer relief. Assuming that surgery will fix your condition is a bit naive. Your best option is likely taking ownership of the condition, getting informed, and making a shared decision with your healthcare team that will utilize the best available evidence to shift the likelihood towards a successful resolution.
Some exercises are listed below that may benefit your shoulder.*
*It's important to consider that there are many causes of shoulder pain. While impingement may be one cause, other causes may be referred pain from the thoracic and/or cervical spine. Fortunately, conservative treatment is also available for these conditions. Here you can book a consult with Dr. Bulman, a chiropractor who conservatively treats many shoulder conditions.