Surgery Provides No Additional Benefit for Shoulder Impingement Syndrome

Is surgery more effective than placebo surgery or referral for supervised exercise therapy in patients with shoulder impingement syndrome?

The long-term follow-up to the initial 2-year study found substantial improvement in all patients, with no benefit of surgery over placebo surgery or physical therapy. (Level of Evidence = 1b−)

The investigators enrolled 210 adults, aged 35 to 65 years, with a clinical presentation of shoulder impingement syndrome (without evidence of arthritis or rotator cuff tear on magnetic resonance imaging) that was not responsive to 3 months of conventional treatment. Patients were first randomized to receive surgery or physical therapy using concealed allocation; patients assigned to surgery underwent diagnostic arthroscopy to rule out tears or other pathology and then, in the operating room, were randomized again to receive arthroscopic subacromial decompression or kept in the operating theater without further intervention for the length of time of a typical decompression (to keep everyone unaware of treatment assignment). Analysis was by intention to treat, meaning that patients were analyzed as part of the group to which they were initially assigned. After 10 years, pain at rest and pain with movement was better in all groups, but there was no clinically important difference between patients who received decompression and patients who received diagnostic arthroscopy or supervised exercise. The study might not have had enough power to find a difference between surgery and exercise (without diagnostic arthroscopy), if one truly exists.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government and foundation

Allocation: Concealed

Setting: Outpatient (any)

Reference: Kanto K, Bäck M, Ibounig T, et al.; Finnish Shoulder Impingement Arthroscopy Controlled Trial (FIMPACT) Investigators. Arthroscopic subacromial decompression versus placebo surgery for subacromial pain syndrome: 10 year follow-up of the FIMPACT randomised, placebo surgery controlled trial. BMJ. 2025; 391: e086201.