Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions  using the contact form below. 

You go to the doctor with a complaint of severe shoulder pain. The pain is at the top and side of your shoulder. You tell your doctor that the pain is much worse when you do anything where you have to reach over your head. You also have a hard time sleeping at night because the pain is worse when you lay down. You may get an MRI or an examination. Your doctor may be looking for a full range of motion in your shoulder even with pain at every point. For us, in our office, full range of motion, even with pain, is a good sign we can help with stem cell treatments.

Once the pain is determined to come from subacromial space of the shoulder, that is the area of the rotator cuff tendons and the subacromial bursa, then rotator cuff tendinopathy, (shoulder impingement) is often diagnosed. The impingement occurs when the Acromion’s (the shoulder bone highlighted in red in the illustration below) underside, presses against the rotator cuff tendons, wear and tearing at them.

The surgery to fix this is not effective – surgeons suggest not even offering it

In the late 1980’s and early 1990’s Arthroscopic subacromial decompression (ASD) was developed to be able to go in and shave away the Acromion and give the tendon’s more space.

Initial reports indicated good success rate, “Eighty-eight percent of the cases were rated “satisfactory” (excellent or good), and 12% were rated “unsatisfactory” (fair or poor),” when performed by experienced physicans.(1)

As the years went on however doctors began to doubt the surgery. 

The Acromion (shown in red). The rotator cuff tendons are trapped BodyParts3D is made by DBCLS. – Polygon data is from BodyParts3D – Image Wikicommons

In 2013, Dr. Robert Zaray Tashjian published research the Clinical journal of sports medicine suggesting that surgical interventions for subacromial impingement syndrome do not reveal one surgical technique to be better than another, nor do they show that surgery is superior in any way to conservative interventions.(2)

Further, data in the medical journal Arthroscopy showed when young athletes have arthroscopic stabilization surgery, it must be emphasized to the patients and their families that the recurrence rate (the need for another surgery) following arthroscopic procedures is higher in young people than in the adult population.(3)

Research like this suggests that shoulder impingement surgery may not be the fastest way back to sports or activity and the prospect of more surgery needs to be considered.

A patient with problems of the rotator cuff or shoulder impingement may think that surgery will be a quick fix. However, surgery is an invasive procedure that often requires lengthy recovery and physical therapy even if it is successful. Further, even “successful” surgery may not relieve the pain, and shoulder weakness can remain. Complications can also include nerve damage and increased weakness.

One study from doctors at New York University and published in The Journal of the American Academy of Orthopaedic Surgeons.noted that “most patients experience pain relief and functional improvement following arthroscopic rotator cuff repair, but some continue to experience symptoms post-operatively. Patients with so-called failed rotator cuff syndrome, that is, with continued pain, weakness, and limited active range of motion following arthroscopic rotator cuff repair, present a diagnostic and therapeutic challenge.”(4)

2018: Subacromial decompression no better than placebo surgery

The University of Helsinki reports on a landmark study from their researchers published July 19, 2018 in the British Medical Journal,

In a landmark study published this week. . . Finnish researchers show that one of the most common surgical procedures in the Western world is probably unnecessary. Keyhole surgeries of the shoulder are useless for patients with “shoulder impingement”, the most common diagnosis in patients with shoulder pain.

“These results show that this type of surgery is not an effective form of treatment for this most common shoulder complaint. With results as crystal clear as this, we expect that this will lead to major changes in contemporary treatment practices,” said the study’s principal investigators chief surgeon Mika Paavola and professor Teppo Järvinen from the Helsinki University Hospital and University of Helsinki.

“By ceasing the procedures which have proven ineffective, we would avoid performing hundreds of thousands useless surgeries every year in the world”, Järvinen points out.

Shoulder Impingement Surgery Alternatives

Although “impingement” refers specifically to pressure on the tendons and bursa in the shoulder, it is a generalized term often used to refer to shoulder pain of unknown origin. Other terms used to describe pain that cannot be pinpointed are tendinitis, tendinosis, and bursitis. When a patient comes into our office we will perfrom a detailed physical examination of the shoulder looking for pain generators. Spots on the shoulder that elicit a pain response when pressed. Typically these are the spots of damage.

By isolating the areas that are damaged and injecting these spots with stem cells we can be confident that healing can occur. I explain this in the video below.


Ask Dr. Darrow about shoulder injuries

 

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1 Ellman H. Arthroscopic subacromial decompression: analysis of one-to three-year results. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 1987 Jan 1;3(3):173-81.

2 Tashjian RZ. Is there evidence in favor of surgical interventions for the subacromial impingement syndrome? Clin J Sport Med. 2013 Sep;23(5):406-7. doi: 10.1097/01.jsm.0000433152.74183.53.

3 Castagna A, Delle Rose G, Borroni M, Cillis BD, Conti M, Garofalo R, Ferguson D, Portinaro N. Arthroscopic stabilization of the shoulder in adolescent athletes participating in overhead or contact sports. Arthroscopy. 2012 Mar;28(3):309-15. doi: 10.1016/j.arthro.2011.08.302. Epub 2011 Nov 30.

3 Strauss EJ, McCormack RA, Onyekwelu I, Rokito AS. Management of failed arthroscopic rotator cuff repair. J Am Acad Orthop Surg. 2012 May;20(5):301-9.

4 Lee DH, Kwack KS, Rah UW, Yoon SH. Prolotherapy for refractory rotator cuff disease: retrospective case-control study of 1-year follow-up. Arch Phy. Med Rehabil. 2015 Aug 5. pii: S0003-9993(15)00594-8. doi: 10.1016/j.apmr.2015.07.011.

5 von Wehren L, Blanke F, Todorov A, Heisterbach P, Sailer J, Majewski M. The effect of subacromial injections of autologous conditioned plasma versus cortisone for the treatment of symptomatic partial rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2015 May 28.

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