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Objective To assess the efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy, a placebo surgical intervention, and with a non-operative alternative, exercise therapy, in a more pragmatic setting. Design Multicentre, three group, randomised, double blind, sham controlled trial. Setting Orthopaedic departments at three public hospitals in Finland. Participants 210 patients with symptoms consistent with shoulder impingement syndrome, enrolled from 1 February 2005 with two year follow-up completed by 25 June 2015. Interventions ASD, diagnostic arthroscopy (placebo control), and exercise therapy. Main outcome measures Shoulder pain at rest and on arm activity (visual analogue scale (VAS) from 0 to 100, with 0 denoting no pain), at 24 months. The threshold for minimal clinically important difference was set at 15. Results In the primary intention to treat analysis (ASD versus diagnostic arthroscopy), no clinically relevant between group differences were seen in the two primary outcomes at 24 months (mean change for ASD 36.0 at rest and 55.4 on activity; for diagnostic arthroscopy 31.4 at rest and 47.5 on activity). The observed mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were −4.6 (95% confidence interval −11.3 to 2.1) points (P=0.18) at rest and −9.0 (−18.1 to 0.2) points (P=0.054) on arm activity. No between group differences were seen between the ASD and diagnostic arthroscopy groups in the secondary outcomes or adverse events. In the secondary comparison (ASD versus exercise therapy), statistically significant differences were found in favour of ASD in the two primary outcomes at 24 months in both VAS at rest (−7.5, −14.0 to −1.0, points; P=0.023) and VAS on arm activity (−12.0, −20.9 to −3.2, points; P=0.008), but the mean differences between groups did not exceed the pre-specified minimal clinically important difference. Of note, this ASD versus exercise therapy comparison is not only confounded by lack of blinding but also likely to be biased in favour of ASD owing to the selective removal of patients with likely poor outcome from the ASD group, without comparable exclusions from the exercise therapy group. Conclusions In this controlled trial involving patients with a shoulder impingement syndrome, arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy at 24 months. Trial registration Clinicaltrials.gov NCT00428870.

Hypothesis The purpose of the study was to establish radiologic and clinical occurrence of glenohumeral arthrosis after arthroscopic Bankart repair. Materials and methods Between January 1994 and December 1998, an arthroscopic Bankart repair was performed in 187 patients at our institution. We were able to assess clinical and radiologic glenohumeral arthrosis in 72 of the 101 patients who met the inclusion criteria (74 shoulders) (71%) after a 13-year follow-up. An additional 9 patients were interviewed by telephone. Radiologic arthrosis was evaluated with the Samilson-Prieto classification and clinical arthrosis with an arthrosis-specific quality-of-life questionnaire (Western Ontario Osteoarthritis of the Shoulder test). In addition, functional impairment was assessed with the Constant score and subjective satisfaction with a questionnaire. Results Radiologic arthrosis was diagnosed in 50 of 74 shoulders (68%), with 40 (80%) of them classified as mild. The mean score on the Western Ontario Osteoarthritis of the Shoulder questionnaire was 280 points (85% of the best possible score), which is considered relatively good. The mean Constant score was 78 points, and 75% of the patients were extremely satisfied or satisfied with the final results of operative treatment. Discussion The radiologic evaluation and self-assessment of the patients imply that the incidence of glenohumeral arthrosis after arthroscopic Bankart repair is quite common but the symptoms are generally mild and comparable to nonoperative treatment. Conclusion Arthrosis rarely causes more than minor subjective symptoms or a minor objectively perceived disadvantage during 13 years' follow-up.

In the present study final-year medical students' degree of theoretical knowledge and rate of successful performance of emergency procedures was assessed. A questionnaire was sent to all final-year medical students in Finland in 1997 (n=504) in all five medical faculties. The response rate was 80.2% (n=404). The questionnaire included questions on theoretical knowledge and successful performance of 10 emergency procedures. Over 90% of the final-year medical students knew the theory of emergency procedures, with the exceptions of chest tube insertion (84%), pericardiocentesis (47%), and planning and starting fluid infusion for an infant (83%), and over 90% had successfully performed insertion of an intravenous line (100%) and intubation of an adult (90%). However, fewer than 7% of the students had successfully performed chest tube insertion, planned fluid infusion for an infant, or pericardiocentesis. Males had significantly higher odds ratio than females for performing insertion of the intravenous line and intubation of an infant. Students with working experience had higher odds ratios for performing cardiopulmonary resuscitation. The highest overall frequency of the procedure performance was at the university in which a student logbook was systematically used. Conclusions are that final-year medical students have good theoretical knowledge of emergency procedures, but practical teaching should be encouraged, since even in emergency procedures students' experience of practical measures was low.

In the present study, medical students' research activity was assessed. All of the 545 medical students at the University of Helsinki in spring term 1997 were provided with a structured, self-admin...