Clinical Inquiry: Is arthroscopic subacromial decompression effective for shoulder impingement?

A It’s impossible to say for certain in the absence of randomized controlled trials. However, in patients whose impingement symptoms don’t improve after 3 to 6 months, arthroscopic subacromial decompression (ASD) is associated with modest (about 10%) longterm improvement in pain and function compared with open acromioplasty or baseline (strength of recommendation [SOR]: B, cohort studies). Patients older than 57 years may do better with surgery than physical therapy (SOR: B, single cohort study).