Surgical widening of the subacromial space for the treatment of lower shoulder pain

A suspected cause of pain below the shoulder blade is insufficient space between the shoulder blade and the shoulder joint, leading to increased pressure on the muscles, tendons and bursae. One possible treatment is surgical widening of the subacromial space. This operation, which is usually performed on an outpatient basis, widens the space available in the shoulder and reduces the pressure. New studies indicate that physiotherapy or other conventional treatments can achieve the same effect, hence this report. As well as the medical aspects, it also investigates the legal, social, ethical and organisational problems associated with alternative procedures.

In various studies, the comparison between the operation and treatment with physiotherapy did not reveal any significant differences. The same applied to studies in which the control group only underwent sham surgery. A further study comparing the results after widening of the subacromial space with those experienced by patients who received no treatment at all found that the operation resulted in less pain and a functional improvement. However, these results are not very meaningful, since the study participants knew whether they had undergone surgery or not. Safety was not affected in any of these cases. A cost comparison showed that the surgical procedure involved much higher costs than all the non-surgical treatments. The use of physiotherapy instead of surgical widening of the subacromial space would have saved over 9 million Swiss francs in 2020.

The report concludes that surgical widening of the subacromial space offers no significant advantages over the conservative approach. However, the alternative treatment with physiotherapy may result in cost savings.