Applied Evidence
A practical guide to shoulder injuries in the throwing athlete
Repeatedly throwing a ball can take a toll on an athlete’s shoulder. Prompt diagnosis and treatment hinges on asking some targeted questions and...
Two other studies found improvements in pain and function
Two other prospective cohort studies didn’t use a comparison group but followed changes in standardized shoulder pain and function scores for 5 to 6 years after ASD. In one study, pain decreased 6 points on a 10-point visual analog scale by 6 months postop (P<.001).3 In both studies, a 9% to 10% improvement in function was seen between 6 months and 5 to 6 years after surgery.3,4
A third cohort study that asked patients about overall pain and satisfaction 8 to 11 years after ASD found that most were “very” or “quite” satisfied and half were pain-free.5,6
Rotator cuff tears found less likely with ASD
An anatomic study obtained ultrasounds of patients 13 to 17 years after ASD and compared the findings to rotator cuff ultrasounds of the general population.7 Patients who had ASD were 22% less likely to demonstrate rotator cuff tears at the end of the study (no statistics were reported to measure significance).
RECOMMENDATIONS
Guidelines from the Washington State Department of Labor and Industry state that patients who should undergo isolated subacromial decompression (with or without acromioplasty) need to have documented subacromial impingement syndrome with magnetic resonance imaging evidence of rotator cuff tendonopathy or tear, have undergone 12 weeks of conservative therapy (including at least active assisted range of motion and home-based exercises), and have had a subacromial injection with a local anesthetic that has provided documented relief of pain.8
No current guidelines are available from national or international orthopedic or sports medicine organizations.