Decompression Surgery, Better Diagnostic Terms and the Power of Words

Jared's argument is not that impingement never happens, but that it is not shown to cause pain or cuff pathology and need not be corrected. Exercise matched surgery at ten years, and placebo-controlled trials, including the 2018 Lancet study and the FIMPACT trial, found real decompression no better than placebo. A 2019 meta-analysis, a BMJ guideline and a Cochrane review with high certainty evidence all reach the same conclusion, so exercise should be the first-line treatment. Alternative terms include rotator cuff related shoulder pain, favored in a 2019 consensus paper, subacromial shoulder pain and nonspecific shoulder pain. These describe the location of symptoms rather than a single mechanism and allow exercise to lead management. Interviews by Cuff and Littlewood show that patients told they have impingement picture bone wearing away a tendon and doubt physiotherapy can help. A case of a patient sent round between imaging, injections and referrals shows how fear and low expectations build before physiotherapy begins.