Shoulder pain is very common; approximately two-thirds of people experience it at some point during their life. One of the most common treatment methods to relieve this pain is subacromial decompression, a keyhole surgery to remove the source of swelling in the shoulder blade. However, recent reviews of the treatment, through controlled trials by CSAW in the UK and FIMPACT in Finland, has questioned the effectiveness of the procedure.

According to the BMJ, the surgery does not “provide important improvements in pain, function, or quality of life compared with placebo surgery or other options.” Nonetheless, from 2007 to 2017, the number of subacromial decompression procedures nearly doubled in England.

So what can be done to ensure the most effective procedures are always carried out for patients?

Having worked in the NHS for more than 20 years, this kind of research is naturally beneficial to medical professionals. Doctors can only carry out procedures initially learnt during their medical training, but the hope is that this will evolve with new research and evidence, such as this recent investigation into shoulder pain surgery.

In the NHS, surgeries and procedures are standardised in line with the latest evidence. For example, new procedures introduced into the system have to receive approval through the local Trust’s Governance Framework.

Following the publication of this new evidence, the NHS has put surgical treatment for chronic shoulder pain on a list of ‘procedures of limited value’. Subacromial decompression will now only be performed under specific circumstances, resulting in savings of £75 million per year for the NHS.

For those suffering from chronic shoulder pain, the Royal College of Surgeons recommends surgical decompression as a last resort. Before surgery is considered, rest, physiotherapy and painkillers should be used, and if necessary, steroid injections.
Providing safe, efficient services for patients is part of the NHS code of governance; new evidence concerning procedures used in the NHS is crucial. It will not be the first or the last trial showing that we are doing something that is less effective than previously thought. Evolving our medical practice in line with the latest evidence will enable us to ensure we are consistently providing the most effective treatment possible for patients.

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