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Course Objectives and Description

The rotator cuff is a group of tendons that holds the shoulder joint in place allowing people to lift their arm and reach overhead. Some people can develop pain in their shoulder related to wear and tear of the rotator cuff.

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There may also be inflammation of the shoulder tendons or bursa another part of the shoulder that helps it move , and pressure on the tendons by the overlying bone when lifting the arm up impingement. Often the pain is made worse by sleeping on the affected shoulder and moving the shoulder in certain directions. Surgery on your rotator cuff may include removing part of your bone to take the pressure off the rotator cuff tendons acromioplasty , removing any swollen or inflamed bursa the small sack of fluid that cushions the shoulder joint , and removing any damaged tissue or bone to widen the space where the tendons pass subacromial decompression.

Most rotator cuff surgery is now performed arthroscopically surgical instruments are inserted through a small incision or key hole to perform surgery. This Cochrane Review is current to 22 October We included eight trials participants , comparing surgery with placebo fake surgery or other non-operative treatment, such as exercise in people with impingement of the shoulder rotator cuff tendons. The number of participants ranged from 42 to , mean age from 42 to 65 years, and duration of follow-up from one year up to 12 to 13 years.

Five trials failed to report funding sources, three received funding from non-commercial foundations, and one trial author was paid by an instrument company.

Course Content

Two trials participants met our criteria for inclusion for our main comparison, surgery versus placebo. Subacromial decompression resulted in little benefit to people at one-year follow-up. Pain lower scores mean less pain :. Function 0 to ; higher scores mean better function :.

Surgery | General and Visceral Surgery Review

Health-related quality of life higher scores mean better quality of life :. No serious adverse events were reported in the trials. In observational studies the rate of serious adverse events was between 0. In people with painful shoulder impingement, high-certainty evidence shows that subacromial decompression surgery does not improve pain, function or health-related quality of life compared with placebo surgery, and moderate-certainty evidence downgraded due to imprecision , shows no improvement in the number of people reporting treatment success.

Study Tools

We are uncertain if surgery is associated with more adverse events compared with no surgery. Serious adverse events including deep infection, pulmonary embolism , nerve injury, and death can occur following shoulder surgery. The data in this review do not support the use of subacromial decompression in the treatment of rotator cuff disease manifest as painful shoulder impingement. High-certainty evidence shows that subacromial decompression does not provide clinically important benefits over placebo in pain, function or health-related quality of life.

Including results from open-label trials with high risk of bias did not change the estimates considerably. Due to imprecision, we downgraded the certainty of the evidence to moderate for global assessment of treatment success; there was probably no clinically important benefit in this outcome either compared with placebo , exercises or non-operative treatment.

Surgery for rotator cuff disease is usually used after non-operative interventions have failed, although our Cochrane Review, first published in , found that there was uncertain clinical benefit following subacromial decompression surgery. To synthesise the available evidence of the benefits and harms of subacromial decompression surgery compared with placebo , no intervention or non-surgical interventions in people with rotator cuff disease excluding full thickness rotator cuff tears.

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We included randomised and quasi-randomised controlled trials RCTs of adults with rotator cuff disease excluding full-thickness tears , that compared subacromial decompression surgery with placebo , no treatment, or any other non-surgical interventions. As it is least prone to bias , subacromial decompression compared with placebo was the primary comparison. Other comparisons were subacromial decompression versus exercises or non-operative treatment.

Major outcomes were mean pain scores, shoulder function, quality of life, participant global assessment of success, adverse events and serious adverse events. The primary endpoint for this review was one year. Review as guest. General and Visceral Surgery Review. Add to cart. Add to Favorite. Reutter Schwarz Reutter. Publication Date:.

General and Visceral Surgery Review

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  5. Features: Succinctly covers the major areas in general and visceral surgery—anatomy, etiology,disease patterns, symptoms, diagnosis, and therapy—with a focus on "what you need to know" for the exam Provides nearly instructive surgical descriptions and clear operative illustrations Includes state-of-the-art minimally invasive and fast-track surgical techniques Breaks topics into concise, digestible chunks of information that facilitate quick memorization Offers targeted information that is comprehensive but not excessive—does not overload you with extraneous material Optimally structured, clearly presented, and packed with helpful study aids, this book is the go-to companion for all students and residents specializing in general and visceral surgery and preparing for the medical residency board exams.

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