Welcome to ‘On the Table’ – UPMC Sports Surgery Clinic’s orthopaedic advances podcast hosted by Dr Andy Franklyn-Miller, Consultant Sports & Exercise Medicine Physician at SSC.

The purpose of the podcast is to explore the reasons behind making a decision to operate in common orthopaedic conditions and explore the latest evidence and post-operative strategies.

In Episode Five, we are delighted to speak to Diarmuid Molony, Consultant Orthopaedic Surgeon specialising in shoulder and elbow surgery at UPMC Sports Surgery Clinic.

This episode focuses on the topic of decision making around subacromial surgery which is often controversial.

Shownotes:

01:47
What are the causes of subacromial pain in an athlete? And what are the 1st steps in managing this before referral?

04:56
What does the clinical examination allow you to differentiate?

05:57
Does Plain X-Ray help in decision making?

06:53
What additional help does MRI imaging provide?

08:50
What role does the injection of steroid have in these patients?

10:16
Can rotator cuff tears also mimic subacromial impingement

12:06
We often hear “failure of rehabilitation” – what does rehabilitation mean to you?

14:46
Underdosing and over-prescription of exercise rehabilitation, is it a problem?

16:59
Differences between Athletic and less athletic populations in management?

18:17
What decision-making steps are there when considering surgery?

19:45
Does adhesive capsulitis commonly co-exist?

22:43
What surgical options exist?

23:20
The Finnish Shoulder Impingement Arthroscopy Controlled Trial (FIMPACT) compared the surgical treatment of shoulder impingement syndrome to placebo surgery and found some surprising results – has that changed your practice?

27:45
What is decompression surgery?

29:50
What is the post-operative period dictated by?

33:00
What are the differences in subacromial surgery and capsulitis surgery?

Papers mentioned in the podcast

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial.
Paavola M, Malmivaara A, Taimela S, Kanto K, Inkinen J, Kalske J, Sinisaari I, Savolainen V, Ranstam J, Järvinen TLN; Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT) Investigators.
BMJ. 2018 Jul 19;362:k2860

Longitudinal study of use and cost of subacromial decompression surgery: the need for effective evaluation of surgical procedures to prevent overtreatment and wasted resources.
Jones T, Carr AJ, Beard D, Linton MJ, Rooshenas L, Donovan J, Hollingworth W.
BMJ Open. 2019 Aug 28;9(8):e030229.
Trials. 2015 May 9;16:210. doi: 10.1186/s13063-015-0725-y.

The CSAW Study (Can Shoulder Arthroscopy Work?) – a placebo-controlled surgical intervention trial assessing the clinical and cost-effectiveness of arthroscopic subacromial decompression for shoulder pain: study protocol for a randomised controlled trial.

Beard D1, Rees J2, Rombach I3, Cooper C4, Cook J5, Merritt N6, Gray A7, Gwilym S8, Judge A9, Savulescu J10, Moser J11, Donovan J12, Jepson M13, Wilson C13, Tracey I14, Wartolowska K15, Dean B16, Carr A17; CSAW Study Group.

About Mr Molony

Mr Diarmuid Moloney has a personal website www.dmorthopaedics.ie