By Linda Carroll / Reuters Health
Surgery for shoulder pain that is not caused by injury has no better results than non-surgical options or placebo surgery and comes with potential harm, the expert group concluded.
The international group of clinicians, researchers and patients focused only on what is called rotary cuff disease, unlike the rotator cuff injuries that lead to tearing of the tendon in the joint, which may require recovery surgery.
Their recommendations are based on two systematic evidence reviews that include seven randomized controlled trials of 1,014 patients, one of which focuses on the benefits and disadvantages of so-called decompression surgery for rotary cuff disease, and the other examines whether surgery has led to significant improvements in pain, movement and quality of life.
In people who have pain in the shoulder without injury, the most likely cause is degeneration of the tendon on the rotary cuff, said senior author of the study Dr. Rudolf Pulman, orthopedic scientist at the OLVG Department of Orthopedics in Amsterdam.
"In fact, there is no real evidence that surgery is useful for any type of tetanus in the human body," Pulman said in an e-mail. "Shoulder pain is multifactorial, and non-shoulder-like psychological and social factors-are very important for reporting."
When Baulman and colleagues analyzed the evidence, they found that after a year there was little difference between patients who received surgery and those who did not. For example, in a pain scale of 1 to 10, with 10 representing the greatest pain, the average pain rating for patients who received surgery was 2.6, compared with 2.9 among those who did not.
When it comes to returning the function, on a scale of 1 to 100, with 100 being the best function, the patients who underwent surgery rated an average of 72, while those who did not have surgery rated 69 .
Another factor in the group's decision was the risk of adverse side-effects of the operation. These include death, infections, blood clots, problems associated with anesthesia and a condition called a frozen shoulder.
The best management for patients is a combination of physical therapy, exercise programs, anti-inflammatory drugs and steroid injections, wrote in the Bulgarian Journal of Medicine.
"Pain in the shoulder can be painful and patients need support and compassion," Pulman said. – Evidence shows that surgery works, as well as placebo-surgery or physiotherapy. Surgeons need to realize this and assure the patient that the pain will rebound and that the surgery has potential side effects that can make things worse.
The new line attempts to "pay attention to people who have tendon jerking on the rotary cuff, which is associated with many different names, including rotary cuff disease or subacromic pain and shoulder syndrome," said Dr. Edward . McFarland, Professor of Orthopedics and Shoulder by Wayne N Lewis and Director of the Shoulder at Johns Hopkins University in Baltimore.
– With age, tendons degenerate. We're not sure why this is happening, but all the tendons in the body become a little weaker when we get older, "McFarland said, not in the guidance panel.
He suspects that the positive results that patients experience with the decompression procedure may be due, at least in part, to the need to stop the joint after surgery.
The new direction may not only discourage doctors from offering the surgery but may also reduce the likelihood of reimbursement by insurance companies, said Dr. Charles Pobbin, orthopedic surgeon and orthopedic surgeon at New York-Presbyterian / Columbia University Irving Medical Center York City.
And while patients may want faster results than they would receive in non-surgical treatment, they should be informed about the potential side of the shoulder, "said Jobin, who is also not involved in the panel.
There is also a chance of injury from regional anesthesia used in the procedure, Jobin said. About one in 10,000 or 100,000 ends with nerve trauma or a problem. This is extremely rare, but when it happens, it can be devastating. You come in for a painful shoulder and end with a weak hand, a numb paw or a pain on the arm that does not disappear. "