Oxford (dpa) – When shoulder pain occurs, some patients currently undergo surgery: If the space between the shoulder joint and the bony projection on the scapula above it is too narrow, doctors sometimes perform a minimally invasive procedure. In this scapular widening, also called "decompression," they remove some bone or tissue. The aim is to create space and relieve pressure on tendons, for example, in order to alleviate pain. However, as British scientists now report in the medical journal "The Lancet," many of these procedures could potentially be avoided.

For their study, they investigated whether the operation led to greater pain reduction than a sham procedure. It has long been known that the patient's expectation of improvement is helpful not only with medication: even when a patient undergoes surgery but the actual procedure is not performed, the placebo effect often produces surprising results.

To investigate this in relation to acromioclavicular expansion, they subjected approximately 100 patients to either surgery or a sham procedure without bone removal. Another 100 patients did not undergo surgery but served as an additional control group.

The researchers found no statistically significant difference between surgery and placebo intervention. Six and twelve months after the start of the study, patients in both groups reported only marginally greater improvements than the untreated participants, in whom pain also decreased somewhat due to spontaneous healing effects.

“The results of our study suggest that surgery offers no clinically significant advantage over no treatment, and that scapular expansion is no better than a placebo procedure,” explains study author Andrew Carr. His colleague David Beard, also a researcher at Oxford University, emphasizes that pain medication, physiotherapy, or steroid injections should be used instead of surgery.

When asked, surgeon Felix Zeifang from the University of Heidelberg described the study as "a very well-designed study".

In his opinion, shoulder blade surgeries are still performed too frequently despite previous studies, while conservative treatments such as physiotherapy help at least two out of three patients. "Surgery should only be considered after months of unsuccessful conservative therapy," the surgeon explains. He adds that responsible shoulder surgeons don't resort to surgery so readily.

While Zeifang believes surgery should still be considered for certain patients, sports orthopedist Andreas B. Imhoff from the Technical University of Munich considers it appropriate only when, for example, calcifications have caused changes in the bone. While his clinic practically never performs scapular expansions anymore, this is far too common among practicing surgeons. "Therefore, I very much hope that this study will change the practice of orthopedic surgeons," says Imhoff. At the same time, he, like Zeifang, mentions that the study, despite its promising approach, has weaknesses. For example, the study physicians sometimes operated on very few patients, which could compromise the comparability of the results.

Up to now, the German healthcare system has tempted doctors to perform more surgeries "to fill existing operating room capacity, their own surgical logbook, or their own bank accounts," explains Stefan Sauerland from the Institute for Quality and Efficiency in Health Care (IQWiG). Almost two years ago, based on similar findings, arthroscopy for knee osteoarthritis was removed from the statutory health insurance benefits catalog. This should now also be discussed for shoulder surgeries, says Sauerland. But patients, too, must learn "that more medicine is not necessarily better medicine, but often even worse medicine," he explains.

Even though German patients are likely to benefit from the new findings, the study would hardly have been possible in Germany, says Joerg Hasford, chairman of the Working Group of Medical Ethics Committees. This is because sham procedures were performed on some of the participants. While they were informed about this possibility, they still underwent surgery and received general anesthesia without any direct benefit. "I think most, if not all, ethics committees in Germany would have refused approval," says Hasford. He adds that, partly due to the illicit medical experiments conducted during the Nazi era, standards in Germany are stricter than in England or the USA. When asked, the study authors pointed out that ethical aspects were considered "very carefully" and that the relevant ethics committee had granted its approval. 

Second opinion before operations on the spine, joints, for problematic pain and coordinated care for back pain

As you often hear in the media, many back and joint surgeries are unnecessary and therefore avoidable. Especially in the case of back pain or joint pain, conservative therapies such as specialized pain management, physical therapy, or relaxation techniques are a suitable alternative to surgery for many conditions. This also applies to patients who have already undergone spinal surgery.

For this reason, Techniker Krankenkasse has entered into a contract with selected pain centers. This allows you to obtain a well-founded second opinion regarding your planned spinal or joint surgery. At the same time, you can be offered specialized pain therapy as part of an integrated, interdisciplinary treatment for your pain.

In each center, pain therapists, physiotherapists, and psychotherapists work hand in hand. The team focuses intensively on the patient and their symptoms. The experts then consult with one another and, if necessary, suggest alternative therapies. The outcome is discussed with both the patient and their treating physician.

There are other ways to do things so that things can get better soon

The special advantage for TK-insured individuals: In urgent cases, you will receive an appointment with the medical team within two days. Otherwise, waiting times of several weeks or even months are common.

Participation requirements

If you are scheduled for spinal surgery, your doctor will issue a referral for inpatient hospital treatment. To participate in this program, simply present the referral at our pain center. Alternatively, your doctor can refer you directly to us to determine whether the planned inpatient procedure is necessary or whether specialized pain therapy is recommended. You can bring any existing medical records, such as test results or X-rays, with you.

Registration

You can register by calling 0431-20099-400 or by email: zweitmeinung@schmerzklinik.de

Your advantages at a glance:

  • Unnecessary and stressful operations can be avoided.
  • They will be shown the risks of the planned treatment as well as treatment alternatives – thus eliminating any doubts.
  • The examination is carried out by selected specialists from various fields.
  • If needed, you will receive an appointment within two days.
  • The team of experts will coordinate with your treating physician – so you don't have to make the decision alone.

More information about the integrated care second opinion program: