Oxford Shoulder Score used as primary outcome measure to assess effectiveness of surgery

30th November 2017

Oxford Shoulder Score used in Lancet-published study of arthroscopic subacromial decompression.

A recent publication in The Lancet by leading surgeons and researchers at Oxford University and Bristol presents findings on the use of the Oxford Shoulder Score (OSS) as the primary outcome measure when assessing the efficacy of arthroscopic subacromial decompression (ASD) surgery for treating subacromial pain over conventional arthroscopy or no intervention at all.

Shoulder pain is a substantial socioeconomic burden – the key points being:

  • 2.4% of all primary care consultations in the UK
  • 4.5m visits to physicians in the USA annually
  • Subacromial pain (the subject of the Lancet paper) accounts for up to 70% of all shoulder pain problems and can impair the ability to work or do household tasks
  • The mean annual cost of treating patients with shoulder pain is estimated at €4,139 (excluding costs of sick leave and secondary care).

ASD is a surgical technique regularly used to treat shoulder pain and restrictions in shoulder function. The effectiveness of this technique is uncertain with competing evidence of its benefit to patients, for example over exercise therapy alone. ASD surgery, which involves the removal of bone and involved soft tissue, is being used more regularly in England, with a seven fold increase in such operations between 2000 (2,523 operations) and 2010 (21,355 operations).

The findings of the research published in the paper (by using the OSS as the primary outcome measure) show that:

  • although those undergoing surgery (either subacromial decompression surgery or conventional arthroscopy) had better outcomes than those receiving no treatment, the difference was not clinically important
  • the ASD technique appeared to offer no benefit over arthroscopy only
  • the difference between the surgical groups and no treatment group might be a result of a placebo effect or postoperative physiotherapy.

The combination of these findings questions the value of the ASD technique and the authors of the paper recommend communicating such facts to the patient during the shared decision making process when considering care pathway.


The Oxford Shoulder Score is a short, easy to complete, 12-item Patient Reported Outcome (PRO) Measure or PROM owned, licensed and supported by the Clinical Outcomes team at Oxford University Innovation.

To view The Lancet paper follow this link.




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