Statement in response to recent studies regarding subacromial decompression by BESS and BOA

The British Elbow and Shoulder Society (BESS) promotes evidence based practice and is leading the way in delivering a number of publicly funded multi-centre clinical trials to inform and improve clinical care. BESS members contributed significantly in delivering the recently published Placebo Controlled Randomised Surgical Trial for Subacromial Shoulder Pain (published in the Lancet).

This trial has shown that the mechanism by which Arthroscopic Subacromial Decompression (ASAD) surgery provides improvement is now uncertain. The trial also demonstrates that some patients can improve without surgery.

Based on the results of this trial, BESS and the British Orthopaedic Association will be bringing together all key stakeholders including clinicians, physiotherapists, General practitioners, patients, and commissioners  to update the 2014 NICE commissioning guidelines for subacromial pain. These updated guidelines will inform best management for both patients and clinicians considering ASAD.

Until publication of the new guidelines we recommend careful patient selection and informed shared decision making for ASAD in this patient group.

Mr Peter Brownson DM FRCS Ed FRCS (Tr & Orth)
President, British Elbow and Shoulder Society 

Mr Rohit Kulkarni
Chair Chapter H Expert Working Group

Ian Winson MB ChB FRCS
Past-President, British Orthopaedic Association 

Professor Peter Kay
National Clinical Director Role for Musculoskeletal Disease, NHS England

Prof Andy Carr ChM DSc FRCS FMedSci
Head of CSAW study group  

Prof David Beard, MSc, MA, DPhil, FRCS (hon)
Co-Chief Investigator, CSAW study