These authors reviewed the available evidence on subacromial decompression (know by some as SAD). Even though evidence in support of this procedure is lacking, it is still one of the most common surgical procedures performed on the shoulder. Their conclusions are listed below.
» Currently, the 2 most common indications for performing a subacromial decompression are subacromial pain syndrome refractory to nonoperative treatment and repair of rotator cuff tears.
» Multiple, high-quality randomized controlled trials showed that subacromial decompression did not provide improvements in pain, function, or quality of life compared with a placebo surgical procedure or other conservative treatments for patients with subacromial pain syndrome.
» Similarly, several randomized controlled trials failed to prove any functional or structural advantage when performing rotator cuff repairs with or without subacromial decompression.
» Imaging studies showed that subacromial decompression did not prevent the development or progression of rotator cuff tears. Moreover, similar retear rates were reported between patients in which rotator cuff repairs were performed with or without subacromial decompression.
» In conclusion, subacromial decompression did not provide any clinical or structurally substantial benefit for the treatment of subacromial pain syndrome or the surgical repair of rotator cuff tears.
This review supports the findings published a decade ago: Published evidence relevant to the diagnosis of impingement syndrome of the shoulder. That abstract is reproduced below
BACKGROUND: Acromioplasty for impingement syndrome of the shoulder is one of the most common orthopaedic surgical procedures. The rate with which this procedure is performed has increased dramatically. This investigation sought high levels of evidence in the published literature related to five hypotheses pertinent to the concept of the impingement syndrome and the rationale supporting acromioplasty in its treatment.
BACKGROUND: Acromioplasty for impingement syndrome of the shoulder is one of the most common orthopaedic surgical procedures. The rate with which this procedure is performed has increased dramatically. This investigation sought high levels of evidence in the published literature related to five hypotheses pertinent to the concept of the impingement syndrome and the rationale supporting acromioplasty in its treatment.
METHODS: We conducted a systematic review of articles relevant to the following hypotheses: (1) clinical signs and tests can reliably differentiate the so-called impingement syndrome from other conditions, (2) clinically common forms of rotator cuff abnormality are caused by contact with the coracoacromial arch, (3) contact between the coracoacromial arch and the rotator cuff does not occur in normal shoulders, (4) spurs seen on the anterior aspect of the acromion extend beyond the coracoacromial ligament and encroach on the underlying rotator cuff, and (5) successful treatment of the impingement syndrome requires surgical alteration of the acromion and/or coracoacromial arch. Three of the authors independently reviewed each article and determined the type of study, the level of evidence, and whether it supported the concept of the impingement syndrome. Articles with level-III or IV evidence were excluded from the final analysis.
RESULTS: These hypotheses were not supported by high levels of evidence.
CONCLUSIONS: The concept of impingement syndrome was originally introduced to cover the full range of rotator cuff disorders, as it was recognized that rotator cuff tendinosis, partial tears, and complete tears could not be reliably differentiated by clinical signs alone. The current availability of sonography, magnetic resonance imaging, and arthroscopy now enable these conditions to be accurately differentiated. Nonoperative and operative treatments are currently being used for the different rotator cuff abnormalities. Future clinical investigations can now focus on the indications for and the outcome of treatments for the specific rotator cuff diagnoses. It may be time to replace the nonspecific diagnosis of so-called impingement syndrome by using modern methods to differentiate tendinosis, partial tears, and complete tears of the rotator cuff.
Comment: The coracoacromial arch is an important stabilizer of the proximal humerus against superiorly directed loads. Contact between the cuff and the arc is normal. Sacrifice of this structure can lead to anterosuperior escape and pseudoparalysis.
Comment: The coracoacromial arch is an important stabilizer of the proximal humerus against superiorly directed loads. Contact between the cuff and the arc is normal. Sacrifice of this structure can lead to anterosuperior escape and pseudoparalysis.
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