Oxford (dpa) - When there is pain in the shoulder, some patients come to the operating table: If the space between the shoulder joint and the bony process above it on the shoulder blade is too narrow, doctors sometimes carry out a minimally invasive procedure. During this expansion of the shoulder blade, also called “decompression,” you remove some bone material or tissue. They want to create space and relieve pressure on tendons, for example, to relieve pain. But as British scientists now write in the specialist magazine “Lancet”, many of the interventions could possibly be dispensed with.

For their study, they examined whether the operation leads to a greater reduction in pain than a sham procedure. It has long been known that the patient's expectation of improvement is not only helpful with medicines: even if a patient goes under the knife but the actual procedure is not carried out, the placebo effect often has amazing effects.

To investigate this for acromion expansion, they subjected around 100 patients to either the operation or a sham procedure without removing bone material. Another 100 patients were not operated on but served as an additional control group.

The researchers found that there was no statistical difference between surgery and placebo intervention. Six and twelve months after the start of the study, patients from both groups reported only slightly greater improvements than the untreated test subjects, in whom the pain also decreased somewhat due to spontaneous healing effects.

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

When asked, the surgeon Felix Zeifang from the University of Heidelberg described the examination as a “very well-conducted study”.

In his opinion, despite previous studies, shoulder blade operations are still used too frequently, while conservative treatments such as physiotherapy would help at least two out of three patients. “Operation can only be discussed after months of unsuccessful conservative therapy,” explains the surgeon. Doctors who do responsible shoulder surgery would not be so quick to resort to the knife, he says.

While, according to Zeifang, operations should still be considered for certain patients, according to sports orthopedist Andreas B. Imhoff from the Technical University of Munich, they are only appropriate if calcification has caused changes to the bone. While shoulder blade expansions are practically no longer carried out at his clinic, this is the case far too often with colleagues in private practice. “In this respect, I very much hope that this study will change the behavior of practicing orthopedic surgeons,” says Imhoff. At the same time, like Zeifang, he mentions that the investigation has weaknesses despite the promising approach. In some cases, the study doctors only operated on very few patients, which could affect comparability.

So far, the German health system has tempted doctors to operate more frequently "in order to fill existing operating room capacities, their own operating room catalog or their own account," explains Stefan Sauerland from the medical testing institute IQWiG. Almost two years ago, based on similar results, joint endoscopy for knee osteoarthritis was removed from the catalog of services offered by statutory health insurance companies. This should now also be discussed for shoulder procedures, says Sauerland. But patients also have to learn “that more medicine is not necessarily better medicine, but often even worse medicine,” he explains.

But even if German patients are likely to benefit from the new findings in the end, the study would hardly have been possible in this country, says Joerg Hasford, chairman of the working group of medical ethics committees. This is because sham procedures were carried out on some of the test subjects. They were informed about this possibility - but they were operated on and given general anesthesia without being able to expect any direct benefit. “I think most, if not all, ethics commissions in Germany would have refused approval here,” says Hasford. Also due to inadmissible medical experiments during the Nazi era, the standards in this country are stricter than in England or the USA. When asked, the study authors pointed out that ethical aspects had been considered “very carefully” and that the responsible ethics committee had given its approval.  

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

As you often hear from the media, many back and joint operations are unnecessary and therefore avoidable. Especially in the back area or joint pain, conservative therapies such as special pain therapy, physiotherapy or relaxation procedures are an adequate alternative to surgery for many complaints. This also applies to patients who have already undergone spinal surgery.

For this reason, the Techniker Krankenkasse has concluded a contract with selected pain centers. This way you can get a well-founded second opinion on your planned spine or joint surgery. At the same time, you can be offered specialized pain therapy for integrated, interdisciplinary treatment of your pain.

Pain therapists, physiotherapists and psychotherapists work hand in hand in each center. The team deals intensively with the patient and his complaints. The experts then consult with each other and, if necessary, make a suggestion for an alternative therapy. The result is discussed with both the patient and the treating doctor.

There can be another way to make things better soon

The special advantage for those with TK insurance: In urgent cases, you can get an appointment with the medical team within two days. Otherwise there are often waiting times of several weeks to months.

Participation requirements

If you are to have an operation on your spine, your doctor will issue you with a prescription for hospital treatment. To take part in this offer, simply present the certificate to our pain center. Alternatively, your doctor can refer you directly to us to clarify whether the planned inpatient procedure is necessary or whether special pain therapy should be used. You can bring any medical documents you may have, such as medical reports or x-rays, with you there.

Registration

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

Your benefits at a glance:

  • Unnecessary and stressful operations can be avoided.
  • You will be shown the risks of the planned treatment as well as treatment alternatives - this will eliminate any doubts.
  • The examination is carried out by selected specialists from various disciplines.
  • If necessary, you can get an appointment within two days.
  • The team of experts coordinates with your treating doctor - so you ultimately don't have to make the decision alone.

More about the integrated care program Second opinion: