When Should I Consider Surgery For Shoulder Impingement Syndrome?

When Should I Consider Shoulder Surgery For Shoulder Impingement Syndrome ( Now known as Sub-acromial Pain Syndrome) ?

Shoulder pain can be very debilitating and we can be tempted to turn to surgery to resolve pain. Sub-acromial decompression surgery has been controversial over the last few years with many people questioning whether its any more beneficial than placebo surgery.

Stick with us as we help you inform yourself so you can make the best decision for you.

The following surgery compared physio vs arthroscopy ( sham surgery) vs sub-acromial decompression.

Shoulder pain is the 3rd most prevalence musculoskeletal disorder that presents to GP’s, with 3% of adults presenting with new shoulder pain at GP’s yearly. (1-5)


Shoulder Pain

66.7% will experience shoulder pain at some point in their life (1, 2).

It is important that we differentiate between other commons signs of shoulder pain such as 

  • Rotator cuff tendinopathy
  • Shoulder arthritis
  • Adhesive capsulitis ( frozen shoulder)
  • Acromioclavicular disorders and referral from the neck/sinister pathology


What Did The Study Involve?

This recent study took 210 patient between the age of 35-65 who had had clinical signs of ‘subacomical impingement’ and performed MRI with contrast to rule out a cuff tear. Then they went on to perform diagnostic arthroscopy.

If patients had more than grade III tear it was repaired and the candidate removed from study. If the patient had Grade I or II were included in the study.

This may seem strange but many people have asymptomatic cuff tears.



How Did They Make The Study Fair?

The participants were randomised, but blinding wasn’t completely possible because the surgeon knew whether they had performed ‘sham’ surgery or the ‘real’ surgery or physiotherapy and the patients knew they were in the exercise group because they had not received surgery.

The findings were interesting as there were slightly lower pain scores in the Arthroscopic decompression group than exercise based but this did not reach the scientific clinical significant agreed in the trial. This means the slight differences may be due to other factors not related to the trial. When you look a the graph you can see its very similar. 


So Shoulder Surgery Wasn’t Significantly Better At 24 Months Than Either Sham Surgery Or Exercise….

This multicentre, randomised, placebo controlled trial involving patients with shoulder impingement syndrome showed that arthroscopic subacromial decompression was not superior to diagnostic arthroscopy, with regard to outcomes assessed at the end of a 24 month follow-up period. Although both groups had significant improvement in both primary outcomes, the patients assigned to ASD had no clinically relevant improvement over those assigned to diagnostic arthroscopy.”

Please check out the photo which explains the article and you can see the full article here…


What Does That Mean For You?

It’s very important to make the right choice for you. Physiotherapy is a safe treatment for shoulder pain. You don’t have the risks of surgery with general anaesthetic such as stroke, heart attack or blood clot, infection or an adverse reaction to anaesthetic drugs. 

It is reassuring to see that we can get the same result without the invasive measures. The most important thing for success with any form of injury or pain is patient buy in. If you fully commit to the process results are much quicker.

If you have any questions about shoulder pain or your injury please call 0117 290 0242 or book online here.


Speak soon.


Nicole and The Physio Crew Team




Paavola Mika, Malmivaara Antti, Taimela Simo, Kanto Kari, Inkinen Jari, Kalske Juha et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial BMJ 2018; 362 :k2860