Management of shoulder pain has been estimated to account for 4.5 million visits to the doctor and $3bn (£2.3bn; €2.6bn) each year in the US alone. 44-70% of patients with shoulder pain are diagnosed with shoulder impingement syndrome. Although various non-operative treatment modalities are recommended as initial treatment for patients with shoulder impingement, subacromial decompression has become one of the most frequently performed orthopaedic procedures in the world...BUT DOES IT ACTUALLY HELP?

On this week’s episode, Prof. Teppo Järvinen (@shamteppo) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss the results from his latest clinical trial – the FIMPACT trial - that was recently published in the BMJ.

Teppo is a Professor of Orthopaedics and Traumatology at the University of Helsinki and Helsinki University Hospital, and is head of the Finnish Centre for Evidence-Based Orthopaedics. He recently organised the 2018 Too Much Medicine symposium that took place in Helsinki, Finland. http://too-much-medicine.com/

In this 15 minute conversation, Prof. Järvinen addresses:
∙ shoulder impingement and subacromial decompression
∙ a brief overview of the FIMPACT trial
∙ the results of the trial and how to integrate the findings into clinical practice
∙ what does too much medicine mean for orthopaedic surgery
∙ the future of sham surgery


Further reading:
Paavola Mika, Malmivaara Antti, Taimela Simo, Kanto Kari, Inkinen Jari, Kalske Juha et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial BMJ 2018; 362 :k2860 https://www.bmj.com/content/362/bmj.k2860
FIDELITY infographic: https://www.bmj.com/content/bmj/362/bmj.k2860/F1.large.jpg
Beard, David J., et al. "Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial." The Lancet 391.10118 (2018): 329-338. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32457-1/fulltext
Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013;369:2515–24. https://www.nejm.org/doi/10.1056/NEJMoa1305189?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov
FIDELITY study video: https://www.youtube.com/watch?v=RaDWkJHmEB0
Savulescu, Julian, Karolina Wartolowska, and Andy Carr. "Randomised placebo-controlled trials of surgery: ethical analysis and guidelines." Journal of medical ethics (2016): medethics-2015.https://jme.bmj.com/content/42/12/776