SHOULDER PAIN - Arthroscopy vs conservative intervention?

https://www.facebook.com/notes/sigurd-mikkelsen/shoulder-pain-arthroscopy-vs-conservative-intervention/10152201532595792

SHOULDER PAIN - Arthroscopy vs conservative intervention?

7 de febrero de 2014 a la(s) 5:23

Just a quick share (slightly edited copy/paste) from a discussion in another group since I know many of my FB-friends will like to see the relevant references in one thread:

"...another aspect is surgical interventions after trauma or for correction of severe congenital malformations, but RCT 's have undeniably not favored surgical interventions over conservative measures lately.

Shi - 2014: The role of acromioplasty for management of rotator cuff problems - where is the evidence? http://1.usa.gov/1eEQg6l

Judge - 2014: Temporal trends and geographical variation in the use of subacromial decompression and rotator cuff repair of the shoulder in England: http://bit.ly/1bCyIXi

Kukkonen - 2013: The waiting time on operatively treated non-traumatic rotator cuff tears:http://bit.ly/M0Fwo2

Dorrestijn - 2009: Conservative or surgical treatment for subacromial impingement syndrome?A systematic review: http://bit.ly/LDon37

Or injection therapy:

Crawshaw - 2010: Exercise therapy after corticosteroid injection for moderate to severe shoulder pain - a large pragmatic randomised trial: http://bit.ly/ic48z0

This recent study also seriously questions the use of surgery for other musculoskeletal conditions:

Sihvonen - 2013: Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear: http://1.usa.gov/1bvHOBQ

+ this:

Wolf - 2006: Randomized surgical trials and "sham" surgery: Relevance to modern orthopaedics and minimally invasive surgery: http://1.usa.gov/1bBIXed

Attempts on diagnosing painful shoulders is also mildly challenging :

Hanchard - 2013: Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement: http://bit.ly/11y3WMh

Lewis - 2013: Subacromial impingement syndrome and rotator cuff tendinopathy: The dilemma of diagnosis: http://bit.ly/15DiXx5

Maybe because of the weak correlation between radiographic findings and symptoms?

Tempelhof - 1999: Age-related rotator cuff tears normal in asymptomatic shoulders, but does not equal pain: http://1.usa.gov/VKvINC

Zanetti - 2000: MRI after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic shoulders: http://bit.ly/1bHUpoX

Miniaci - 2002: MRI of the shoulder in asymptomatic professional baseball pitchers :http://1.usa.gov/1eISfq7

Jost - 2005: MRI findings in throwing shoulders - 93% shoulders had findings, 37% were symptomatic: http://bit.ly/Hi1TNV

Huston - 2005: The role of MRI in a Division 1 university sports medicine program:http://bit.ly/1nl0fyl . 

The studies above combined with increasing knowledge about other potential (other than structural) driving mechanisms behind pain, should make us reconsider many aspects of what really could be the cause for painful shoulders:

Ratcliffe - 2013: Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review: http://bit.ly/1izS3tj

McFarland - 2013: Impingement is not impingement: the case for calling it "Rotator Cuff Disease": http://1.usa.gov/19sMTPT (PS: I don't agree on calling it "rotator cuff disease" and there's also other groups debating whether to call it "subacromial pain syndrome", but I think it will end on something similar to the already vaguely defined, but established "patellofemoral pain syndrome")

Dean - 2013: Why does my shoulder hurt? A review of the neuroanatomical and biochemical basis of shoulder pain: http://1.usa.gov/19bcB55

Rio - 2013: The pain of tendinopathy: Physiological or pathophysiological? http://bit.ly/J8jQV6

Littlewood - 2013: The central nervous system - An additional consideration in ' rotator cuff tendinopathy ' and a potential basis for understanding response to loaded therapeutic exercise:http://bit.ly/1bAR375

I hope you understand me correctly, I'm not saying that NO-ONE ever should undergo surgical interventions, but recent research suggests that there are far fewer that should be operated than what we are seeing now. My opinion is that surgical interventions should only be considered after a minimum of 3 months of systematic, exercise-based and cognition-targeted conservative care paralleled with modern pain-education."