RAG rating
Document type
Clinical policy
Hertfordshire and West Essex ICB
Output type
Clinical Policies & Evidence-based Interventions

Arthroscopic Sub-acromial Decompression


This policy is a local supplement to the national EBI programme guidance on arthroscopic shoulder decompression for subacromial shoulder pain. See https://ebi.aomrc.org.uk/ . It aims to provide clarity on the definition of persistent symptoms despite appropriate non-operative management.
Shoulder arthroscopy for other indications is outside the scope of this policy. Please refer instead to the local Shoulder Arthroscopy policy. 


Primary care or MSK community service referral can be considered for surgical opinion for patients who meet ALL the following criteria –
  • Patient has had symptoms for at least 6 weeks from the start of treatment.
  • Symptoms are intrusive and debilitating (for example waking several times a night, pain when putting on a coat)
  • Patient has been compliant with conservative intervention (education, rest, NSAIDs, simple analgesia, appropriate physiotherapy) for at least 6 weeks.
  • Patient has initially responded positively to a steroid injection, but symptoms have returned despite compliance with conservative management.
  • Referral is at least 8 weeks following steroid injection.
  • A shared decision-making conversation has taken place and the patient confirms they wish to have surgery.
Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. Individual cases will be reviewed as per the ICB policy.

  1. Royal College of Surgeons/BESS/BOA (2014) Commissioning guide: Subacromial Shoulder Pain