***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and purpose A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up . The purpose s of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score , rotator cuff status and radiological findings influenced the outcome . Patients and methods 97 patients on the waiting list for arthroscopic subacromial decompression had been r and omised to a specific exercise programme or unspecific exercises ( controls ) .  After 3 months of exercises , the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up . 1 year after inclusion or 1 year after surgery , the number of patients who decided to have surgery in each group was compared . The choice of surgery was related to the baseline Constant-Murley score , ultrasound and radiographs taken at inclusion . Results All patients had improved significantly ( p<0.0001 ) in the Constant-Murley score at the 1-year follow-up . Significantly more patients in the control group decided to have surgery ( 63 % ) than those in the specific exercise group ( 24 % ; p<0.0001 ) . Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear . Patients with partial tears did not differ from those with intact tendons . Interpretation The positive short-term results of specific exercises were maintained after 1 year , and this exercise strategy reduces the need for surgery . Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome . Trial registration number Clinical trials NCT01037673 Introduction Arthroscopic subacromial decompression ( ASD ) is the most commonly performed surgical intervention for shoulder pain , yet evidence on its efficacy is limited . The rationale for the surgery rests on the tenet that symptom relief is achieved through decompression of the rotator cuff tendon passage . The primary objective of this superiority trial is to compare the efficacy of ASD versus diagnostic arthroscopy ( DA ) in patients with shoulder impingement syndrome ( SIS ) , where DA differs only by the lack of subacromial decompression . A third group of supervised progressive exercise therapy ( ET ) will allow for pragmatic assessment of the relative benefits of surgical versus non-operative treatment strategies . Methods and Analysis Finnish Subacromial Impingement Arthroscopy Controlled Trial is an ongoing multicentre , three-group r and omised controlled study . We performed two-fold concealed allocation , first by r and omising patients to surgical ( ASD or DA ) or conservative ( ET ) treatment in 2:1 ratio and then those allocated to surgery further to ASD or DA in 1:1 ratio . Our two primary outcomes are pain at rest and at arm activity , assessed using visual analogue scale ( VAS ) . We will quantify the treatment effect as the difference between the groups in the change in the VAS scales with the associated 95 % CI at 24 months . Our secondary outcomes are functional assessment ( Constant score and Simple shoulder test ) , quality of life ( 15D and SF-36 ) , patient satisfaction , proportions of responders and non-responders , reoperations/treatment conversions , all at 2 years post-r and omisation , as well as adverse effects and complications .  We recruited a total of 210 patients from three tertiary referral centres . We will conduct the primary analysis on the intention-to-treat basis . Ethics and Dissemination The study was approved by the Institutional Review Board of the Pirkanmaa Hospital District and duly registered at Clinical Trials.gov . The findings of this study will be disseminated widely through peer- review ed publications and conference presentations . Trial registration number NCT00428870 ; Pre- results We have compared three different methods of treating symptomatic non-traumatic tears of the supraspinatus tendon in patients above 55 years of age . A total of 180 shoulders ( 173 patients ) with supraspinatus tendon tears were r and omly allocated into one of three groups ( each of 60 shoulders ) ; physiotherapy ( group 1 ) , acromioplasty and physiotherapy ( group 2 ) and rotator cuff repair , acromioplasty and physiotherapy ( group 3 ) . The Constant score was assessed and followed up by an independent observer pre-operatively and at three , six and twelve months after the intervention . Of these , 167 shoulders were available for assessment at one year ( follow-up rate of 92.8 % ) . There were 55 shoulders in group 1 ( 24 in males and 31 in females , mean age 65 years ( 55 to 79 ) ) , 57 in group 2 ( 29 male and 28 female , mean age 65 years ( 55 to 79 ) ) and 55 shoulders in group 3 ( 26 male and 29 female , mean age 65 years ( 55 to 81 ) ) . There were no between-group differences in the Constant score at final follow-up : 74.1 ( sd 14.2 ) , 77.2 ( sd 13.0 ) and 77.9 ( sd 12.1 ) in groups 1 , 2 and 3 , respectively ( p = 0.34 ) . The mean change in the Constant score was 17.0 , 17.5 , and 19.8 , respectively ( p = 0.34 ) . These results suggest that at one-year follow-up , operative treatment is no better than conservative treatment with regard to non-traumatic supraspinatus tears , and that conservative treatment should be considered as the primary method of treatment for this condition Background and purpose — We have previously shown that specific exercises reduced the need for surgery in subacromial pain patients at 1-year follow-up . We have now investigated whether this result was maintained after 5 years and compared the outcomes of surgery and non-surgical treatment . Patients and methods — 97 patients were included in the previously reported r and omized study of patients on a waiting list for surgery . These patients were r and omized to specific or unspecific exercises . After 3 months of exercises the patients were asked if they still wanted surgery and this was also assessed at the present 5-year follow-up . The 1-year assessment included Constant – Murley score , DASH , VAS at night , rest and activity , EQ-5D , and EQ-VAS . All these outcome assessment s were repeated after 5 years in 91 of the patients . Results — At the 5-year follow-up more patients in the specific exercise group had declined surgery , 33 of 47 as compared with 16 of 44 ( p = 0.001 ) in the unspecific exercise group . The mean Constant – Murley score continued to improve between the 1- and 5-year follow-ups in both surgically and non-surgically treated groups . On a group level there was no clinical ly relevant change between 1 and 5 years in any of the other outcome measures regardless of treatment . Interpretation — This 5-year follow-up of a previously published r and omized controlled trial found that specific exercises reduced the need for surgery in patients with subacromial pain . Patients not responding to specific exercises may achieve similar good results with surgery . These findings emphasize that a specific exercise program may serve as a selection tool for surgery Summary Background Arthroscopic sub-acromial decompression ( decompressing the sub-acromial space by removing bone spurs and soft tissue arthroscopically ) is a common surgery for subacromial shoulder pain , but its effectiveness is uncertain . We did a study to assess its effectiveness and to investigate the mechanism for surgical decompression . Methods We did a multicentre , r and omised , pragmatic , parallel group , placebo-controlled , three-group trial at 32 hospitals in the UK with 51 surgeons . Participants were patients who had subacromial pain for at least 3 months with intact rotator cuff tendons , were eligible for arthroscopic surgery , and had previously completed a non-operative management programme that included exercise therapy and at least one steroid injection . Exclusion criteria included a full-thickness torn rotator cuff . We r and omly assigned participants ( 1:1:1 ) to arthroscopic subacromial decompression , investigational arthroscopy only , or no treatment ( attendance of one re assessment appointment with a specialist shoulder clinician 3 months after study entry , but no intervention ) . Arthroscopy only was a placebo as the essential surgical element ( bone and soft tissue removal ) was omitted . We did the r and omisation with a computer-generated minimisation system . In the surgical intervention groups , patients were not told which type of surgery they were receiving ( to ensure masking ) . Patients were followed up at 6 months and 1 year after r and omisation ; surgeons coordinated their waiting lists to schedule surgeries as close as possible to r and omisation . The primary outcome was the Oxford Shoulder Score ( 0 [ worst ] to 48 [ best ] ) at 6 months , analysed by intention to treat . The sample size calculation was based upon a target difference of 4·5 points ( SD 9·0 ) . This trial has been registered at Clinical Trials.gov , number NCT01623011 . Findings Between Sept 14 , 2012 , and June 16 , 2015 , we r and omly assigned 313 patients to treatment groups ( 106 to decompression surgery , 103 to arthroscopy only , and 104 to no treatment ) . 24 [ 23 % ] , 43 [ 42 % ] , and 12 [ 12 % ] of the decompression , arthroscopy only , and no treatment groups , respectively , did not receive their assigned treatment by 6 months . At 6 months , data for the Oxford Shoulder Score were available for 90 patients assigned to decompression , 94 to arthroscopy , and 90 to no treatment . Mean Oxford Shoulder Score did not differ between the two surgical groups at 6 months ( decompression mean 32·7 points [ SD 11·6 ] vs arthroscopy mean 34·2 points [ 9·2 ] ; mean difference −1·3 points ( 95 % CI −3·9 to 1·3 , p=0·3141 ) . Both surgical groups showed a small benefit over no treatment ( mean 29·4 points [ SD 11·9 ] , mean difference vs decompression 2·8 points [ 95 % CI 0·5–5·2 ] , p=0·0186 ; mean difference vs arthroscopy 4·2 [ 1·8–6·6 ] , p=0·0014 ) but these differences were not clinical ly important . There were six study -related complications that were all frozen shoulders ( in two patients in each group ) . Interpretation Surgical groups had better outcomes for shoulder pain and function compared with no treatment but this difference was not clinical ly important . Additionally , surgical decompression appeared to offer no extra benefit over arthroscopy only . The difference between the surgical groups and no treatment might be the result of , for instance , a placebo effect or postoperative physiotherapy . The findings question the value of this operation for these indications , and this should be communicated to patients during the shared treatment decision-making process . Funding Arthritis Research UK , the National Institute for Health Research Biomedical Research Centre , and the Royal College of Surgeons ( Engl and ) Background For the treatment of calcific tendinitis of the shoulder a variety of treatment regimes exist . Commonly used treatment measures include medication with oral analgesics , corticosteroid injections , extracorporeal shockwave therapy , ultrasound guided needling and lavage , and surgical treatment . Earlier cohort studies suggest that patients may benefit from these treatments , but there are few r and omized studies and conflicting evidence about the effectiveness of the various treatments . In the present study we aim to compare the effectiveness of ultrasound guided needling and lavage ( barbotage ) together with a steroid injection to sham barbotage with and without an additional steroid injection . Methods The study will be performed in six secondary -care institutions in Norway and Sweden . It is design ed as a pragmatic , r and omized , three-arm , parallel group , double-blinded , sham-controlled clinical trial with a 2-year follow-up . It will be performed on 210 patients , aged 30 years or older , presenting with painful arc , positive impingement sign and a calcium deposit > 5 mm . R and omization to one of the three treatment options will be performed by using an online central r and omization system . The three treatment groups are barbotage together with a subacromial steroid injection ( the barbotage group ) , sham barbotage together with a subacromial steroid injection ( the steroid group ) or sham barbotage without a subacromial steroid injection ( the placebo group ) . In the placebo group the steroid injection will be replaced by a short-acting local anaesthetic . St and ardized home-based post-treatment physiotherapy will be performed by all patients for 8 weeks . Follow-ups are at 2 and 6 weeks , 4 , 8 , 12 and 24 months after treatment was given and will be performed with the patients and the outcome assessors blinded for group assignment . Primary outcome will be the Oxford shoulder score at 4 month follow-up . Secondary outcome measures are the QuickDASH upper extremity score , the EQ-5D-5L general health score and visual analogue scales for pain at rest , during activity , and at night . Discussion The scientific evidence from this placebo-controlled trial will be of importance for future treatment recommendations in patients with calcific tendinitis . Trial registration Clinical Trials.gov : NCT02419040 , registered 10 April 2015EudraCT : 2015 - 002343 - 34 , registered 23 September 2015 ( retrospectively registered Background : The long-term outcome after the treatment of subacromial impingement syndrome ( SAIS 
    Output:
    
The data in this review do not support the use of subacromial decompression in the treatment of rotator cuff disease manifest as painful shoulder impingement .
High-certainty evidence shows that subacromial decompression does not provide clinical ly important benefits over placebo in pain , function or health-related quality of life .
Including results from open-label trials ( with high risk of bias ) did not change the estimates considerably .
Due to imprecision , we down grade d the certainty of the evidence to moderate for global assessment of treatment success ; there was probably no clinical ly important benefit in this outcome either compared with placebo , exercises or non-operative treatment .