FIMPACT

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial.

Paavola M, Malmivaara A, Taimela S, et al. BMJ (Clinical research ed.) 2018 · PMID 30026230 · doi:10.1136/bmj.k2860

Question

Is subacromial decompression better than placebo (diagnostic) arthroscopy for shoulder impingement?

Design

Multicentre, placebo surgery controlled RCT in Finland with an additional exercise therapy arm.

Patients

Adults with persistent shoulder impingement symptoms despite non-operative treatment.

Intervention

Arthroscopic subacromial decompression

Comparison

Diagnostic arthroscopy alone (and supervised exercise)

Primary outcome

Shoulder pain at rest and on arm activity (VAS) at 24 months

Key result

There was no clinically relevant difference in pain between decompression and diagnostic arthroscopy at two years.

Limitations

Finnish single-country trial with a modest sample; exercise arm comparison was not blinded.

Impact on practice

Published alongside CSAW, it reinforced that decompression should not be offered routinely for impingement-type pain.