The Effect of Arthroscopic Subacromial Decompression in Patients Who Are Non-responders to Non-operative Treatment.

This study is evaluating whether arthroscopic subacromial decompression surgery — a minimally invasive procedure that removes bone spurs or inflamed tissue from beneath the shoulder joint — actually helps patients with shoulder impingement syndrome (SIS) who have not responded to at least 3 months of supervised physiotherapy. Shoulder impingement occurs when tendons in the shoulder are pinched between bones, causing pain and limited movement. While surgery is commonly performed, its benefit over continued non-surgical management is still debated. Patients who have tried and failed conservative (non-surgical) treatment will be randomly assigned to either the surgery or a further non-surgical management approach. Researchers will track pain levels, shoulder function, and quality of life over time to determine whether surgery provides a meaningful benefit in this group of treatment-resistant patients. You may be eligible if: - You have a clinical diagnosis of shoulder impingement syndrome (SIS) - A subacromial injection has provided at least temporary pain relief - You have had shoulder symptoms for at least 6 months - You have completed at least 3 months of supervised shoulder physiotherapy with no meaningful improvement - You have been assessed as a surgical candidate by an orthopedic shoulder specialist You may NOT be eligible if: - You have a serious medical illness (ASA score 4 or higher), inflammatory joint disease, or systemic musculoskeletal disease - You have a full-thickness rotator cuff tear, frozen shoulder, calcified tendonitis, or other shoulder pathology - You have had previous surgery or radiotherapy on the affected shoulder - You are pregnant - You have an ongoing workers' compensation or job rehabilitation case Talk to your doctor to see if this trial is right for you.