Acromioplasty in patients selected for operation by national guidelines

Abstract

Shoulder impingement syndrome is the most common shoulder disorder. Even though conservative treatment is the primary treatment of choice, surgery has increased substantially in several countries during the last 20 years. This has resulted in recommended clinical guidelines for treatment of shoulder impingement syndrome in countries such as The Netherlands and Denmark during recent years. The aim of this study was to investigate the effectiveness of an arthroscopic subacromial decompression in 244 patients selected for surgery according to national clinical guidelines. Patients were included from an Internet-based shoulder and elbow database. They were asked to complete 2 questionnaires consisting of the Oxford Shoulder Score (OSS) and the EuroQol 5-Dimension 3-Level and visual analog scale preoperatively and at 6-month follow-up. All patients were carefully selected for surgery according to the national guidelines, with symptoms persisting for at least 6 months. Furthermore, subgroups related to the OSS were formed to assess the clinical outcome according to preoperative status and age. For the complete study group, an OSS change of 10 (8.8-11.2; P = .0001) was found at 6-month follow-up. No significant difference was found between the genders (P = .17). The largest clinical effect from the intervention was found in the low preoperative OSS (pre-OSS) group, in which a mean change of 17 was found. The moderate and high pre-OSS groups had mean changes of 13 and 5, respectively. Similarly, according to the EuroQol 5-Dimension 3-Level and visual analog scale, the largest improvements were seen in the low and moderate pre-OSS groups. Arthroscopic subacromial decompression is a valid treatment, reducing pain and improving quality of life for patients selected for surgery according to the Danish national guidelines.