Surgeons in the United Kingdom ran a three-way trial on patients with shoulder impingement pain. People were assigned to decompression surgery, to a placebo arthroscopy that opened the joint but removed no bone or tissue, or to no procedure at all.
At six and twelve months, both surgery groups reported similar improvement, and the difference between real decompression and the placebo operation was too small to be considered clinically meaningful. Both scored slightly better than no procedure, a gap also too small to matter clinically.
The result questioned a repair performed hundreds of thousands of times a year worldwide on the assumption that shaving down bone and inflamed tissue relieved pain by removing an obstruction. What small benefit there was seemed tied to having an operation at all, or to the physiotherapy after it, not to removing the bone spur.
Read the original study
Beard et al., The Lancet, 2018 · doi.org/10.1016/s0140-6736(17)32457-1
The spur was not the point.
Source
- Beard, D. J., Rees, J. L., Cook, J. A., Rombach, I., Cooper, C., Merritt, N., Shirkey, B. A., Donovan, J. L., Gwilym, S., Savulescu, J., Moser, J., Gray, A., Jepson, M., Tracey, I., Judge, A., Wartolowska, K., Carr, A. J., Ahrens, P., Baldwick, C., . . . Woods, D. (2018). Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet, 391(10118), 329–338. https://doi.org/10.1016/s0140-6736(17)32457-1