The concept of the “impingement syndrome” and its treatment by acromioplasty (aka subacromial decompression, SAD) were introduced 50 years ago (see this link).
The authors of On Patient Safety: Shoulder “Impingement”—Telling a SAD Story About Public Trust point out that acromioplasty quickly became one of the most commonly performed orthopaedic procedures; its usage increased five-fold between the 1980s and 2005 in the United States. However, evidence progressively accumulated that acromioplasty might be no more effective than physiotherapy. And the concept of “impingement syndrome” became recognized as a waste-basket term that included such diagnoses as bursitis, cuff tendinopathy, rotator cuff tear and biceps tendinitis.
The author and colleagues launched the Finnish Subacromial Impingement Arthroscopy Controlled
Trial (FIMPACT) in 2005. In Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial they concluded that arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy alone at 24 months after surgery. In reflection on this study, the British Medical Journal stated that “Subacromial decompression surgery should not be offered to patients with subacromial pain syndrome.”
The author goes on to point out that acromioplasty remains one of the most frequently performed shoulder surgeries in the world. In considering why this might be, he suggests that surgeons trust their own “experiences” with an operation more than randomized clinical trials. While experience do matter, a surgeon’s experiences suffers from follow-up that is short, does not include standardized data collection, and does not include the large percentage of patients in a surgical practice do not return for follow-up. This is in contrast to the FIMPACT trial that followed 81% of enrolled patients for 5 years and evaluated them using validated endpoints that matter to patients. Finally, the author points out that “procedures that carry greater risk (like shoulder surgery) should be superior to interventions with little or no risk (like shoulder exercises), and certainly superior to placebo interventions (such as the diagnostic arthroscopy performed in their controlled trial).