SURGERY can often seem like a cure all measure for a health problem but what if it is not all it is cracked up to be?

Health leaders in Greater Manchester are shying away from offering surgery for a certain type of shoulder pain because the research just does not add up.

MARY NAYLOR reports.

SHOULDER pain can have a huge impact on your quality of life and for those seeking relief going having surgery can be an attractive option.

However, a lack of hard evidence for the effectiveness of surgery on pain caused by shoulder impingement means doctors are turning towards physiotherapy.

Speaking at a Bolton Clinical Commissioning Group (CCG) meeting, Dr Stephen Liversedge, clinical director of primary care and health improvement said: “[The surgery] seems like a good idea, however, when you look at the research it’s woeful, it’s not good.”

Shoulder impingement is a common cause of shoulder pain, where a tendon (band of tissue) inside the shoulder rubs or catches on nearby tissue and bone as the arm is lifted.

This affects the rotator cuff tendon (rubber tissue connecting the muscles around the shoulder joint to the top of the arm).

This can result in a variety of painful symptoms including pain in the top and outer side of the shoulder, aching at night which can affect sleep, pain when lifting your arm and weakness in your arm.

Shoulder pain is common and affects around 14 in every 100 adults in the UK.

For those with pain caused by shoulder impingement a procedure known as an arthroscopic sub-acromial decompression has been a popular treatment.

The surgery, is carried out using a minimally invasive procedure, it involves making more room for shoulder movement by cutting the ligament and shaving away bone in order to reduce pressure on the muscle allowing it to heal.

The average cost of the procedure in Greater Manchester is £3,360.

According to the National Institute for Health Research (NIHR) in the UK in 2015/16 there were 30,669 admissions for this type of operation funded by the NHS.

The NIHR also notes that the number of times the procedure has been carried out rose rapidly between 2001 and 2010 from 5.2 per 100,000 people to 40.2 per 100,000.

However, despite the procedure’s popularity a number of studies have failed to find that it works or is any more effective than targeted physiotherapy.

One study even suggested that the improvements patients did see were a result of their post-operative physiotherapy.

Amar Rangan, professor of orthopaedic surgery at the James Cook University Hospital in Middlesbrough, has said: "It is time for us to re-consider and refine treatment pathways for this common cause of shoulder pain with more selective use of surgery for patients who are likely to derive the most benefit."

Based on the worrying findings from a number of studies, health leaders in Greater Manchester have issued new guidance to doctors in the region setting out new rules meaning people will only be offered the surgery once all other options have been exhausted.

Doctors on Bolton CCG’s board shared their disappointment about the ineffectiveness of the procedure and how long it had taken for this information to surface.

Dr Romesh Gupta, secondary care specialist said: “There is some lack of coordination somewhere. Someone is doing the research and not conveying to the staff.”

Melissa Maguinness, director of service transformation, said: “It’s not about saving money, it’s about not doing procedures on people that don’t need them.”

Chairman of the board Dr Wirin Bhatiani agreed saying: “This is about doing the right thing at the right time and having the right conversation with our patients.”

Dr Jane Bradford, clinical director of governance and safety on Bolton CCG was presenting the policy to be considered.

She said that she had discussed the procedure with a surgeon at Royal Bolton Hospital and he had been enthusiastic about cutting the numbers.

She said: "He was a great advocate of this. He was pushing for this saying 'I might not need to do this anymore'."

Dr Charles Hendy also flagged up the need for patients to be involved and proactive in their own health. He said: "Patients often have limited benefit [from the surgery] and it's never as good as an original shoulder.

"We have found people need to look after their joints once they have been operated on and often they don't."

The new policy being rolled out across Greater Manchester means in future patients will have to undergo non-invasive treatment including rest and physiotherapy to improve their condition.

They will also be offered initial treatment with steroid injections to the joint before they will be considered for the surgery.

Patients will also be advised that "current evidence informs us that there is uncertainty as to whether arthroscopic sub-acromial decompression is any better than physiotherapy" in a bid to help them understand the implications of undergoing surgery.