Arthroscopic shoulder decompression

For the treatment of

Subacromial shoulder pain

Commissioning position

This intervention is only commissioned if the following criteria have been met:  

there is subacromial pain without an associated diagnosis e.g. rotator cuff tear/acromio-clavicular joint pain/calcific tendinopathy

AND

pain persists after conservative therapy including at least 6 weeks physiotherapy (+ further 6 weeks, if improvement) AND
1 steroid injection (+2nd after 6 weeks, if benefit from 1st and needed to facilitate physiotherapy).

Summary of rationale

Arthroscopic shoulder decompression for pure subacromial shoulder impingement should only offered in appropriate cases. To be clear, ‘pure subacromial shoulder impingement’ means subacromial pain not caused by associated diagnoses such as rotator cuff tears, acromio-clavicular joint pain, or calcific tendinopathy. Non-operative treatment such as physiotherapy and exercise programmes are effective and safe in many cases.

For patients who have persistent or progressive symptoms, in spite of adequate non-operative treatment, surgery should be considered. Evidence for the potential benefits and risks of subacromial shoulder decompression surgery remains inconclusive but suggests possibly no advantage over placebo. This evidence should be discussed with the patient and a shared decision reached between surgeon and patient as to whether to proceed with surgical intervention.