Surgical ‘sham’ for relieving shoulder pain exposed

It’s one of those pains that comes and goes. You reach your arm up to get something out of the closet, and — bingo! — it hits.

Or maybe you turn a certain way during the night, and your shoulder reminds you in no uncertain terms that it’s not a happy camper.

Undefined shoulder pain is one of the most common complaints that doctors hear. And one of the most common “solutions” to that pain that patients hear about is a surgical procedure called “subacromial decompression.”

Now, considering how many times this operation has been performed, you would think that some expert would have long ago asked the question, “Is this surgery actually helping patients?”

But it wasn’t until only recently that a group of doctors came along and attempted to figure that out.

And they discovered that you can save yourself a lot of time, trouble, expense, and risk… just by trying some simple solutions to treat that shoulder pain.

Which is the real ‘sham’?

Shoulder decompression surgery is one of those medical procedures that sounds good on paper.

And that theoretical concept was enough to make this one of the most commonly done orthopedic operations out there. The idea behind it is that as we age, ragged pieces of bone form in the shoulder area and rub against a tendon, causing pain upon certain movements.

To relieve that pain, a surgeon makes a “keyhole” incision, cutting away bone bits along with some soft tissue.

But since the popularity of this procedure has been growing by leaps and bounds (especially among doctors who charge close to $10,000), professor David Beard, a physiotherapist out of the UK’s University of Oxford, decided to put it to the test.

So, he devised a study with 300 patients who had been suffering from shoulder pain for several months. Some got the actual surgery, a second group received a “sham” procedure where no bone or tissue was removed, and a third got no treatment at all.

And surprise, surprise! After six months, there was basically no difference whatsoever in the pain “scores” between those who received the sham versus the real surgery, with both groups reporting some amount of decrease in pain.

As for the group that received no treatment, members had slightly less improvement than the others — but even that difference was called “small” by the researchers.

So, what’s going on? How did doing nothing and doing almost nothing give virtually the same results as cutting away bone and tissue?

The researchers cite that powerful “medicine” known as the placebo effect, along with physical therapy sessions and prescribed rest of the painful arm, as possible reasons.

But whatever the answer to this might be, the real story here is that now we can add this shoulder decompression surgery to a growing list of orthopedic operations that start to look a lot less useful when a spotlight shines on them.

Just last year, we told you about a study that examined the effectiveness of knee surgery for a torn meniscus. It turns out that it was no better than physical therapy and exercise — and exercise was actually found to be superior!

Of course, one of the things the researchers neglected to mention is the amazing ability of the body to start to heal itself when given half a chance. And to help that process along with shoulder pain, experts are now suggesting trying physical therapy and old-fashioned liniments, which can help by “making the skin tingle,” before jumping into any kind of surgery.

As Dr. Richard Baron, president of the American Board of Internal Medicine Foundation, puts it, the general rule of thumb before you agree to any kind of surgical procedure is to always ask your doctor three vital questions:

  1. What can the risks be?
  2. What happens if I don’t do this?
  3. Are there other options?

You may be very surprised by his answers!

“Popular surgery to ease chronic shoulder pain called into question” Patti Neighmond, November 20, 2017, NPR,