Shoulder surgery directed toward “rotator cuff tendinitis,” “rotator cuff disease,” “subacromial pain syndrome,” or “shoulder impingement” is not superior to non-surgical treatment options for relieving pain. These are the findings of an expert panel whose conclusions have been recently published (February 6, 2019) in the British Medical Journal (BMJ). In addition, the panel identified certain potential risks with such surgeries.
The panel’s recommendations are based on two systematic evidence reviews that included seven randomized controlled trials with 1,014 patients who have irritation of a rotator cuff tendon. In the opinion of the lead author of the panel report, Rudolph Poolman, M.D, the abnormality most likely found in people who have rotator cuff related shoulder pain is degeneration of one or more of the rotator cuff tendons.
With the publishing of this panel study Dr Poolman has stated in interviews: “In fact, there is no real evidence that surgery is beneficial for any type of tendinopathy (tendon degeneration) in the human body.” He adds that “shoulder pain is multifactorial” and that there can be several factors that need to be taken into account when attempting to identify the cause of pain in a troublesome shoulder. The mere fact that tendons often degenerate and get weaker as we get older is not a sufficient basis to explain pain or make a surgical recommendation.
When Poolman and his colleagues analyzed the evidence, they found that after one year, there was little difference between patients who underwent surgery and those who did not. And there are also compelling suspicions that the positive results that some patients experience following shoulder decompressive surgery may be due, at least in part, to the requirement that the shoulder be rested after surgery.
Another factor in the panel’s position on shoulder surgery was the risk of side effects. These included death, infections, blood clots, anesthesia-related problems and a condition often called “frozen shoulder.”
Dr. Poolman states that “shoulder pain can be excruciating and patients do need support and compassion” and “the evidence shows that surgery works as well as a placebo surgery or physiotherapy. Surgeons should realize this and reassure the patient that the pain will subside eventually and that surgery has potential side effects that can make matters worse.”
We have an answer for many that suffer with Rotator Cuff Tendinitis, particularly chronic or recurrent cases.
Our office offers a distinctly successful protocol for many Rotator Cuff Tendinitis sufferers that addresses most of the significant muscular/mechanical factors that are involved in this condition. In many cases, particularly those uncomplicated by advanced tendinosis or other co-existing medical issues, we often observe positive results in as soon as 3-5 treatment sessions. We invite those who are suffering with this injury to arrange a consultation with us to determine if our protocols might be right for you.