Introduction sur l’épaule

https://www.bmj.com/content/362/bmj.k2860.full

Management of shoulder pain has been estimated to account for 4.5 million visits to physicians and $3bn (£2.3bn; €2.6bn) financial burden each year in the US alone.12 As 44-70% of patients with shoulder pain are diagnosed as having a shoulder impingement syndrome, annual direct medical costs of this complaint are estimated at more than $1bn in the US.345 The pathognomonic clinical sign of shoulder impingement syndrome, subacromial shoulder pain while lifting the arm, is commonly attributed to “impingement” of the rotator cuff tendons between the humeral head and the overlying acromion. Premised on this rationale, the undersurface of the acromion is smoothened to decompress the passage of the rotator cuff tendon through the subacromial space in a surgical procedure called subacromial decompression. Although various non-operative treatment modalities are recommended as initial treatment for patients with shoulder impingement symptoms,67 subacromial decompression has become one of the most frequently performed orthopaedic procedures in the world.8 With the advent of arthroscopy, the number of subacromial decompression procedures has increased many times between the 1980s and the 2010s.910 We conducted a multicentre, randomised, double blind, placebo surgery controlled trial to assess the efficacy of arthroscopic subacromial decompression (ASD) in patients with shoulder symptoms consistent with shoulder impingement syndrome.