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Shoulder pain – do I need to have a scan and possibly surgery?

It is believed that over 40% of the population have shoulder pain at some stage of their life.  Shoulder impingement is a common diagnosis and involves the compression of tendons between the head of the humerus (your arm bone) and the acromian/clavicular joint (better known as your AC joint).  See the image below for an example of the impingement;

Shoulder pain   – do I need to have a scan and possibly surgery? Bodylogics

When the arm lifts up to your side, and your rotator cuff is weak (see our blog here for more information on this), the tendons that run under the acromion become compressed.  Regular compression of these tendons results in them becoming inflamed and swollen and this then result’s in further pain through greater inflammation.

This pain can often result in people seeking surgery to reduce the pain intensity.  This surgery is called sub acromial decompression surgery.  It is the most common form of shoulder surgery in the world. It involves shaving away part of the acromion bone just above the humerus head to allow the humerus more space to move and reduce compression of the tendons on this bony structure.  However, recent research has shown that this surgery is not actually that beneficial!

Why is this a problem though?  Surely surgery cannot be that bad if so many of these operations happen anyway?  Part of this is true.  Surgery is performed with good intentions and to help get the body back to doing what it does best, which is move!  However, surgery comes with great long term complications.  Any change to the biological make-up of the body can result in the disorganisation of cells, etc… within the system.  When this happens, disease such as tendinopathy and arthritis can start to set in.  Any surgery that takes place can increase your long term chances of arthritis so it is important to be aware of this before proceeding with any operations.

Now for the important part.  A recent research paper showed that sub acromial decompression surgery was no more effective than placebo surgery or a well-constructed exercise rehab programme (1).  The graphs attached below show the difference in scores. 

You will notice that the graph for pain on the exercise chart shows the pain score was slightly higher but this was not a significant difference.  Given the risks of arthritis and other complications associated with any form of surgery, the reduction of pain in this graph should indicate that conservative treatment is a much safer and secure way to reduce symptoms of shoulder pain.

The exercise programme associated with this study can be found by clicking here.  If you are deciding to follow it then please ensure you gain some advice from a clinical profession before undertaking any type of rehab to ensure you are performing the exercises correctly and safely.  Your Physiotherapist, Osteopath, Sports Therapist or Injury Rehab specialist will be well positioned to offer guidance.

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