Policy number: SRP 013
Policy name: Arthroscopic shoulder decompression for subacromial pain
Status: Individual Funding Approval
Effective date: 1 April 2024
Next review date: 1 April 2026
Mid and South Essex ICB commissions Arthroscopic Shoulder Decompression for subacromial pain on a restricted basis.
Arthroscopic subacromial decompression for pure subacromial shoulder impingement should only be 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.
Primary care referral can be considered for surgical opinion for patients who meet ALL the following criteria:
- Patient has had symptoms for at least 3 months from the start of treatment.
- Symptoms are intrusive and debilitating (for example waking several times a night, pain when putting on a coat).
- Patient has been compliant with conservative intervention (education, rest, NSAIDs, simple analgesia, appropriate physiotherapy) for at least 6 weeks.
- Patient has initially responded positively to a steroid injection, but symptoms have returned despite compliance with conservative management.
- Referral is at least 8 weeks following steroid injection.
- Patient confirms they wish to have surgery.
RED FLAG SYMPTOMS
Emergency referral – same day:
- Acutely painful red warm joint e.g. suspected infected joint.
- Trauma leading to loss of rotation and abnormal shape – unreduced shoulder dislocation.
2WW referral to secondary care:
- Shoulder mass or swelling – suspected malignancy.
- Sudden loss of ability to actively raise the arm (with or without trauma) – acute cuff tear.
- New symptoms of inflammation in several joints – systemic inflammatory joint disease (rheumatology referral).
Reference:
Arthroscopic shoulder decompression for subacromial pain EBI