Arthroscopic subacromial decompression surgery involves decompressing the subacromial space by removing the bone spur and any involved soft tissue. Although this procedure is frequently used to manage subacromial shoulder pain, clinical studies have yielded mixed results regarding its effectiveness, and no randomized trials have been conducted. A multicenter study was undertaken to compare the effects of arthroscopic decompression surgery, investigational arthroscopy only (placebo), and no treatment in patients with subacromial shoulder pain.

To be included in the study, patients had to have subacromial pain for at least three months and intact rotator cuff tendons, be eligible for arthroscopic surgery, and have completed a nonoperative management program that included both exercise therapy and at least one steroid injection. Participants were randomly assigned to receive arthroscopic subacromial decompression, investigational arthroscopy, or no treatment. Both surgical groups received standard postoperative care and exercise therapy.

In this study, the primary outcome measure was the Oxford Shoulder Score, which measures changes in shoulder pain and function. The mean score didn't differ between the two surgical groups. A small benefit was observed in both surgical groups compared with no treatment, but these differences weren't clinically important. All three groups showed improvement at six months and at one year. The only study-related complications were frozen shoulders, affecting two patients in each treatment group.

The authors suggest that a surgical placebo effect or postoperative rest and physiotherapy might explain differences in outcomes among those in the surgical groups and those who did not receive treatment. They advise that clinicians share these findings with patients who are considering surgery for shoulder pain.

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