NGC Search Results
Your search criteria:Keyword: Shoulder Impingement Syndrome: Your search found 4 related
guidelines,
Upper extremity musculoskeletal disorders. Brigham and Women's Hospital (Boston) Hospital/Medical Center. 2003. 9 pages.
Shoulder. Work Loss Data Institute - Public For Profit Organization. 2003. 15 pages.
AAOS clinical guideline on shoulder pain. American Academy of Orthopaedic Surgeons - Medical
Specialty Society American Academy of Physical Medicine and Rehabilitation - Medical Specialty
Society American College of Rheumatology - Medical Specialty Society. 2001. 24 pages.
Criteria for shoulder surgery. Washington State Department of Labor and Industries - State/Local
Government Agency [U.S.] Washington State Medical Association - Medical Specialty Society.
1999 (revised 2002). 4 pages.
AHRQ Search Results: 0
PNLG Search Results: 0
CMA Search Results: 0
NeLH Search Results: 1 record
NICE 2003. Extracorporeal shockwave lithotripsy for calcific tendonitis (tendinopathy) of the shoulder
SIGN search: 0
New Zealand Search Results: 0
Cochrane search: 3 records
Corticosteroid injections for shoulder pain
Interventions for shoulder pain
Physiotherapy interventions for shoulder pain
Shoulder Impingement Syndrome
Compression of the rotator cuff tendons and subacromial bursa between the humeral head
and structures that make up the coracoacromial arch and the humeral tuberosities. This
condition is associated with subacromial bursitis and rotator cuff (largely supraspinatus) and
bicipital tendon inflammation, with or without degenerative changes in the tendon. Pain that
is most severe when the arm is abducted in an arc between 40 and 120 degrees, sometimes
associated with tears in the rotator cuff, is the chief symptom. (From Jablonski's Dictionary
of Syndromes and Eponymic Diseases, 2d ed)
Year introduced: 1997
All MeSH Categories
Diseases Category
Musculoskeletal Diseases
Joint Diseases
Shoulder Impingement Syndrome
1. "Shoulder Impingement Syndrome"[MAJR] AND Practice Guideline[ptyp]: 0 records
2. "Shoulder Impingement Syndrome"[MAJR] AND Systematic Review]: 8 records
1: Arthroscopy. 2003 Jan;19(1):34-9.
The relationship between clinical outcomes and the amount of arthroscopic
acromial resection.
Soyer J, Vaz S, Pries P, Clarac JP.
Department of Orthopedic Surgery, Hospital Jean Bernard, Poitiers, France.
j.soyer@chu-poitiers.fr
PURPOSE: In 47 consecutive patients who had a shoulder impingement syndrome
treated by arthroscopic subacromial decompression, we compared the functional
outcome with the amount of the acromion resection. TYPE OF STUDY: Prospective
study. METHODS: The inclusion criteria for patient selection was a chronic
impingement syndrome unresolved by conservative treatment with an intact rotator
cuff or with an irreparable rupture of the rotator cuff. The assessment was
performed with the scoring system of Constant preoperatively and
postoperatively. Quantitative measurements of the acromion resection were made
by comparing preoperative and postoperative anteroposterior radiographic views,
standardized under fluoroscopic control in order to become reproducible and
comparable. There were 39 patients (41 shoulders) available for follow-up at 37
months. RESULTS: The condition of the shoulder, concerning pain, motion and
activities, was improved at the time of follow-up, the mean gain of the total
functional score was 29 points/100. Age, side, activity, duration of pain before
procedure and cuff statement had no influence on preoperative and postoperative
Constant's score. The difference between preoperative and postoperative
measurements of anterior acromion protuberance was significant. There was no
correlation between the amount of the acromion resection and the improvement of
Constant's score (P =.84). CONCLUSIONS: The origin of impingement syndrome is
multi-factorial, and efficiency of arthroscopic decompression may not be only
due to the amount of acromion resection. From these results and a literature
review, this study analyzes several morphologic factors, which could explain the
good results of arthroscopic subacromial decompression in impingement syndrome.
PMID: 12522400 [PubMed - indexed for MEDLINE]
2: Z Orthop Ihre Grenzgeb. 2002 May-Jun;140(3):267-74.
[Musculoskeletal shock wave therapy--current database of clinical research]
[Article in German]
Rompe JD, Buch M, Gerdesmeyer L, Haake M, Loew M, Maier M, Heine J.
Orthopadische Universitatsklinik Mainz, Germany.
During the past decade application of extracorporal shock waves became an
established procedure for the treatment of various musculoskeletal diseases in
Germany. Up to now the positive results of prospective randomised controlled
trials have been published for the treatment of plantar fasciitis, lateral elbow
epicondylitis (tennis elbow), and of calcifying tendinitis of the rotator cuff.
Most recently, contradicting results of prospective randomised
placebo-controlled trials with adequate sample size calculation have been
reported. The goal of this review is to present information about the current
clinical database on extracorporeal shock wave treatment (ESWT).
Publication Types:
Review
Review, Academic
PMID: 12085291 [PubMed - indexed for MEDLINE]
3: Br J Gen Pract. 2002 Feb;52(475):145-52.
A combination of systematic review and clinicians' beliefs in interventions for
subacromial pain.
Johansson K, Oberg B, Adolfsson L, Foldevi M.
Department of Medicine and Care, Faculty of Health Sciences, Linkoping, Sweden.
Kajsa.Johansson@hul.liu.se
The aim of the study is to determine which treatments for patients with
subacromial pain are trusted by general practitioners (GPs) and
physiotherapists, and to compare trusted treatments with evidence from a
systematic critical review of the scientific literature. A two-step process was
used: a questionnaire (written case simulation) and a systematic critical
review. The questionnaire was mailed to 188 GPs and 71 physiotherapists in
Sweden. The total response rate was 72% (186/259). The following treatments were
trusted, ergonomics/adjustments at work, corticosteroids, non-steroidal
anti-inflammatory drugs, movement exercises, acupuncture, ultrasound therapy,
strengthening exercises, stretching, transcutaneous electric nerve stimulation,
and superficial heat or ice therapy. The review, including efficacy studies for
the treatments found to be trusted, was conducted using the CINAHL, EMBASE and
MEDLINE databases. Evidence for efficacy was recorded in relation to
methodological quality and to diagnostic criteria that labelled participants as
having subacromial pain or a non-specific shoulder disorder. Forty studies were
included. The methodological quality varied and only one treatment had
definitive evidence for efficacy for non-specific patients, namely injection of
corticosteroids. The trust in corticosteroids, injected in the subacromial
bursa, was supported by definitive evidence for short-term efficacy. Acupuncture
had tentative evidence for short-term efficacy in patients with subacromial
pain. Ultrasound therapy was ineffective for subacromial pain. This is supported
by tentative evidence and, together with earlier reviews, this questions both
the trust in the treatment and its use. The clinicians' trust in treatments had
a weak association with available scientific evidence.
Publication Types:
Review
Review, Academic
PMID: 11885825 [PubMed - indexed for MEDLINE]
4: ANZ J Surg. 2001 Mar;71(3):172-7.
Arthroscopic subacromial decompression with a holmium:YAG laser: review of the
literature.
Boult M, Wicks M, Watson DI, MacDougal G, Shimmin A, Maddern GJ.
Australian Safety and Efficacy Register of New Inverventional
Procedures--Surgical, Royal Australasian College of Surgeons, North Adelaide,
South Australia.
BACKGROUND: The Australian Safety and Efficacy Register of New Interventional
Procedures-Surgical (ASERNIP-S) undertook to systematically review the
literature regarding arthroscopic subacromial decompression (ASD) using a
holmium:YAG laser for patients with impingement syndrome, with respect to the
safety and efficacy of the procedure. METHODS: Studies on ASD with a holmium:YAG
laser were identified using MEDLINE (1984 to July 2000), EMBASE (1974 to August
2000) and Current Contents (1993 to week 33 2000). A number of search terms were
used: (laser and shoulder) and (surgery or arthroscop* or acromioplasty or
orthopaed* or orthoped* or subacromial decompression or impingement syndrome).
The Cochrane Library was searched from 1966 to issue 3 2000, using the search
terms 'shoulder and surgery'. Human studies were included for patients with
impingement syndrome but without full-thickness rotator cuff tears or
rheumatological disorders, and where shoulder pain had been experienced for more
than 3 months. A surgeon and reviewer independently assessed the retrieved
articles for their inclusion in the review. RESULTS: Seven papers were
identified that related to ASD with a holmium:YAG laser. None of the papers for
review offered high-quality evidence. There were no properly designed randomized
controlled studies. The highest level of evidence came from time series studies.
No quantitative analysis could be undertaken for this review. CONCLUSIONS: Given
the extremely low level of evidence available for this procedure it was
recommended that further research be conducted to establish the safety and
efficacy of the technique. This reinforces the conclusion reached in the
Cochrane review of interventions for shoulder pain where insufficient evidence
was found to either support or refute the efficacy of other interventions for
shoulder pain.
Publication Types:
Review
Review, Tutorial
PMID: 11277148 [PubMed - indexed for MEDLINE]
5: J Shoulder Elbow Surg. 1999 Nov-Dec;8(6):585-9.
The influence of cuff pathology on shoulder function after arthroscopic
subacromial decompression: a 3- and 6-year follow-up study.
Hoe-Hansen CE, Palm L, Norlin R.
Department of Orthopaedics, University Hospital, Linkoping, Sweden.
In the literature operative management of rotator cuff ruptures in the shoulder
varies, from tendon repair to debridement of the cuff lesion combined with
subacromial decompression. This study was made to evaluate whether patients with
intact rotator cuff differed from patients with rotator cuff ruptures regarding
functional outcome after arthroscopic subacromial decompression. We performed a
clinical review of 39 patients with subacromial impingement who all underwent
arthroscopic subacromial decompression; no other surgery was performed. There
were 13 patients with intact cuff, 13 patients with partial-thickness
supraspinatus ruptures, and 13 patients with full-thickness supraspinatus
ruptures < 2 cm. Selection was based solely on the status of the supraspinatus
tendon. Patients with other pathologic conditions were excluded. Follow-up was
performed after 3 and 6 years. The clinical evaluation was performed with the
Constant score and the visual analog pain score. The 3- and 6-year follow-up
(100% follow-up rate) revealed no significant difference between the groups
regarding the Constant scores and the visual analog scale values. Also, no
significant difference was seen among the 3 groups in active range of motion or
strength, and the patients had no appreciable pain. We conclude that the
functional outcome 6 years after arthroscopic subacromial decompression is not
obviously related to the preoperative degree of cuff pathology, even if a total
rupture of small size is present.
PMID: 10633893 [PubMed - indexed for MEDLINE]
6: Bull Hosp Jt Dis. 1998;57(3):145-51.
Open versus arthroscopic decompression for subacromial impingement. A
comprehensive review of the literature from the last 25 years.
Checroun AJ, Dennis MG, Zuckerman JD.
Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, New
York 10003, USA.
The operative management (open versus arthroscopic) of subacromial impingement
was investigated through a search of the English-language literature from 1970
to 1996. Thirty-four clinical studies comprising 1,935 patients met the
following selection criteria: a study published in a peer reviewed journal, a
valid materials and methods section (describing age, gender, number of subjects,
follow-up period, treatment modality, and impingement stage), and acromioplasty
without rotator cuff repair. Six hundred and ninety-eight patients had an open
decompression (OD) and 1,237 had an arthroscopic subacromial decompression (ASD)
for Stage II and III impingement. When possible, only Stage II patients were
reviewed. A few studies combined Stage II and III patients in their results;
thus, the patients were placed into two groups (OD and ASD) composed of four
categories: OD of Stage II impingement (494 patients), OD of Stage II and III
impingement (204 patients), ASD of Stage II impingement (727 patients), and ASD
of Stage II and III impingement (510 patients). The average duration of symptoms
before surgery ranged from 6 months to 43 months in the OD group and 6 months to
61 months in the ASD group. The average age was 41.8 and 42.1 years, clinical
follow-up 6 months to 62 months and 12 months to 41 months in the OD and ASD
groups, respectively. The objective success rates were 83.3% versus 81.4% and
the subjective success rates were 90.0% versus 89.3% for OD versus ASD,
respectively. Return to work ranged from 43% to 100% in the OD group and 74% to
100% in the ASD group. Based on our review, the outcome from ASD is similar to
OD. For persistent stage II primary impingement, we recommend starting with ASD
and reserve OD for surgical failures. ASD allows earlier rehabilitation than OD
because complete detachment of the deltoid is not performed, yet ASD is
technically more demanding and has a long learning curve.
Publication Types:
Review
Review, Tutorial
PMID: 9809180 [PubMed - indexed for MEDLINE]
7: J South Orthop Assoc. 1997 Fall;6(3):197-203.
Shoulder impingement/instability overlap syndrome.
Parker RD, Seitz WH Jr.
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, OH 44195, USA.
Impingement syndrome is one of the most common shoulder problems seen by the
orthopedist. Multidirectional instability is less common but can present with
impingement symptoms. Patients having impingement symptoms due to
multidirectional instability have a syndrome called "impingement/instability
overlap." The purpose of this study is to retrospectively review 50 consecutive
patients with a condition we have coined "impingement/instability overlap"
syndrome. We discuss the criteria, by history and by physical examination, for
inclusion in this category and the results of treatment. Our study shows that
when the primary cause (instability) is treated with rehabilitation and/or
surgery, the secondary symptoms, impingement and pain, can be alleviated.
Conversely, if subacromial decompression is done to treat the secondary
impingement, the primary symptoms, instability and pain, persist. Instability
should be considered the primary etiology in any patient having impingement
symptoms, especially in the younger patient (< 35 years old). Rehabilitative and
surgical treatment should address the pathologic instability.
PMID: 9322200 [PubMed - indexed for MEDLINE]
8: Clin Exp Rheumatol. 1996 Sep-Oct;14(5):561-6.
Local corticosteroid injections in the treatment of rotator cuff tendinitis
(except for frozen shoulder and calcific tendinitis). Groupe Rhumatologique
Francais de l'Epaule (G.R.E.P.).
Goupille P, Sibilia J.
Service de Rhumatologie, C.H.U., Hopital Trousseau, Tours, France.
OBJECTIVE: This review discusses the efficacy of local corticosteroid injections
in the treatment of rotator cuff tendinitis (except for frozen shoulder and
calcific tendinitis) according to the controlled studies published in the
literature. STUDY SELECTION: All controlled studies (13) published between 1955
and 1993 have been included in this review. However, this work is not a
metaanalysis because these studies are not comparable. DATA SYNTHESIS: Several
studies are open to criticism. Local corticosteroid injections seem to be more
effective than placebo and oral non-steroidal antiinflammatory drugs, especially
for pain. Several questions remain unanswered: the true position of this
treatment in the therapeutic strategy of rotator cuff tendinitis, the long term
efficacy and deleterious effects of local corticosteroid injections and the
optimal technique and number of injections. CONCLUSION: Local corticosteroid
injections seem to be effective in the treatment of rotator cuff tendinitis.
However, a controlled study more closely reflecting clinical practice is needed
to confirm these data.
Publication Types:
Review
Review, Tutorial
PMID: 8913661 [PubMed - indexed for MEDLINE]
3. "Shoulder Impingement Syndrome"[MAJR] AND Meta-Analysis[ptyp]: 1 record
Clin J Sport Med. 2003 May;13(3):176-82.
Therapeutic exercise and orthopedic manual therapy for impingement syndrome: a systematic review.
Desmeules F, Cote CH, Fremont P.
Laval University Hospital Research Centre, Laval University, Quebec, Canada.
OBJECTIVE: To review randomized controlled trials evaluating the effectiveness
of therapeutic exercise and orthopedic manual therapy for the treatment of
impingement syndrome. DATA SOURCE: Reports up to October 2002 were located from
MEDLINE, the Cochrane Database of Systematic Reviews, the Physiotherapy Evidence
Database (PEDro), the TRIP database, and the Cumulative Index to Nursing &
Allied Health Literature (CINAHL) using "shoulder" and "clinical
trial"/"randomized controlled trial" as search terms. STUDY SELECTION: Studies
were included if (1) they were a randomized controlled trial; (2) they were
related to impingement syndrome, rotator cuff tendinitis, or bursitis; (3) one
of the treatments included therapeutic exercise or manual therapy. DATA
EXTRACTION: Two independent observers reviewed the methodological quality of the
studies using an assessment tool developed by the Cochrane Musculoskeletal
Injuries Group. Differences were resolved by consensus. DATA SYNTHESIS: Seven
trials met our inclusion criteria. After consensus, the mean methodological
score for all studies was 13.9 +/- 2.4 (of 24). Four studies of 7, including the
3 trials with the best methodological score (67%), suggested some benefit of
therapeutic exercise or manual therapy compared with other treatments such as
acromioplasty, placebo, or no intervention. CONCLUSIONS: There is limited
evidence to support the efficacy of therapeutic exercise and manual therapy to
treat impingement syndrome. More methodologically sound studies are needed to
further evaluate these interventions.
4. "Shoulder Impingement Syndrome"[MAJR] AND Randomized Controlled Trial[ptyp]: 14 records
1: Acta Orthop Scand. 2003 Aug;74(4):408-14.
Open versus arthroscopic subacromial decompression: a prospective, randomized
study of 34 patients followed for 8 years.
Husby T, Haugstvedt JR, Brandt M, Holm I, Steen H.
Rikshospitalet University Hospital, Department of Orthopaedics, NO-0027 Oslo,
Norway. torstein.husby@rikshospitalet.no
In a randomized prospective study, we selected 15 patients for arthroscopic
subacromial decompression (ASD) and 19 patients for open subacromial
decompression (OSD). All had impingement syndrome (Neer grade II), and had been
unsuccessfully treated without surgery for more than 6 months. The UCLA Shoulder
Rating Scale, Visual Analogue Scales for pain and satisfaction, isokinetic
dynamometer recordings and physical testing were assessed preoperatively and at
1 (except isokinetic testing), 3, 6, and 12 months, and, finally, 8 years after
surgery. We found essentially no differences in the clinical tests between the
groups during this period. The use of ASD or OSD seems to be a matter of
cosmesis and personal preference.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 14521290 [PubMed - indexed for MEDLINE]
2: Orthopade. 2002 Jul;31(7):652-7.
[Extracorporeal shockwave therapy (ESWT) as therapeutic option in supraspinatus
tendon syndrome? One year results of a placebo controlled study]
[Article in German]
Schmitt J, Tosch A, Hunerkopf M, Haake M.
Klinik fur Orthopadie und Rheumatologie, Philipps-Universitat, Baldingerstrasse
3, 35033 Marburg/Lahn. schmitt2@mailer.uni-marburg.de
Extracorporeal shock wave therapy (ESWT) is seen as a therapeutic option in the
treatment of chronic supraspinatus tendinitis by some authors. To test whether
ESWT comprising 3 x 2000 pulses with the positive energy flux density ED+ of
0.33 mJ/mm2 is clinically superior to a sham ESWT treatment, a prospective,
randomized, single-blinded, placebo-controlled study with an independent
observer was performed. Forty patients were treated either by verum ESWT or sham
ESWT under local anesthesia. Target criteria were the age-corrected Constant
score, pain at rest and during activity on a visual analogue scale, and
subjective improvement. Patients who reported no subjective improvement after 12
weeks were deblinded and received verum ESWT if they had belonged to the placebo
group (partial crossover). The results of the verum group lie within the range
of results for ESWT published by other authors. Patients in the placebo group
with local anesthetic showed equally good results. At 12 weeks, and 1 year after
intervention, no difference could be found between the verum and placebo groups
regarding Constant score, pain, shoulder function, or subjective improvement.
The nonresponders to the placebo ESWT continued to show no improvement after
receiving verum ESWT. This contradicts a specific ESWT effect. Based on the
results of this placebo-controlled study, ESWT appears to have no clinically
relevant effect on supraspinatus tendinitis. The study underlines the importance
of a control group in evaluating new treatment methods for diseases with unknown
natural history.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12219663 [PubMed - indexed for MEDLINE]
3: Z Orthop Ihre Grenzgeb. 2002 Jul-Aug;140(4):375-80.
[Self-training versus conventional physiotherapy in subacromial impingement
syndrome]
[Article in German]
Werner A, Walther M, Ilg A, Stahlschmidt T, Gohlke F.
Orthopadische Klinik, Universitatsklinikum Dusseldorf.
werner@med.uni-duesseldorf.de
AIM: This prospective, randomized study was aimed to compare the effect of a
standardized self-training versus standard physiotherapist-supervised exercises
in the non-operative treatment of shoulder impingement syndrome types Neer I and
II. METHOD: 40 patients with subacromial impingement I/II were randomized to two
groups. Group 1 performed a mostly isometric self-training after instruction by
a physiotherapist, group 2 received prescriptions for physiotherapy and
"strengthening exercises for the rotator cuff". Follow up was performed after 6
and 12 weeks with the use of the constant score (unpondered). Patient
satisfaction with the treatment was controlled by VAS (1 - 6). RESULT: After 12
weeks, patients of group 1 had performed the exercises 5 x/week for 15 minutes.
Patients of group 2 had received 30 sessions in average. Patients of group 1
improved from a mean of 59 points (39.5 - 86) to a mean of 68 points (37 - 88)
after 6 and 75 points (65 - 90) after 12 weeks. Patients of group 2 improved
from 60.5 points (41 - 83) to 67 points (39.5 - 92) and 72 points (43 - 93),
respectively. Patient satisfaction was higher in the self-training group (1.9 :
2.8). CONCLUSION: Strengthening of the centering muscles around the humeral head
leads to good results in the non-operative treatment of subacromial impingement.
Self-training after instruction showed no difference to
physiotherapist-supervised exercises in the non-operative treatment of
subacromial impingement.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12183784 [PubMed - indexed for MEDLINE]
4: Strahlenther Onkol. 2002 Jun;178(6):314-20.
Comment in:
Strahlenther Onkol. 2003 Feb;179(2):129-30; author reply 131-2.
[The effectiveness of radiation treatment in comparison with extracorporeal
shockwave therapy (ESWT) in supraspinatus tendon syndrome]
[Article in German]
Gross MW, Sattler A, Haake M, Schmitt J, Hildebrandt R, Muller HH,
Engenhart-Cabillic R.
Klinik fur Strahlentherapie und Radioonkologie, Philipps-Universitat Marburg.
gross@mailer.uni-marburg.de
BACKGROUND AND AIM: Supraspinatus tendinitis is usually treated by
antiinflammatoric drugs, local injections, physiotherapy or low-dose
irradiation. A novel approach is the use of Extracorporeal Shock Wave Therapy
(ESWT) if conservative therapies have failed. So far there has been no
controlled study comparing the effectiveness of ESWT with an established
conservative method of therapy such as X-ray stimulation radiotherapy. PATIENTS
AND METHOD: 30 patients with chronic supraspinatus tendinitis were admitted into
the prospective randomized study. After randomization the patients were treated
either with X-ray stimulation radiotherapy with 6 x 0.5 Gy on the ICRU reference
point (1 fraction/day) with cobalt 60 gamma rays or three times with 2000 pulses
(energy flux density ED+ 0.1 mJ/mm2) in 1 week intervals using a Storz Minilith
SL1. Primary endpoint was the age-corrected constant score 3 months after
intervention. RESULTS: Acute side effects caused by the irradiation were not
observed, as expected. One patient described pain and one patient showed a
moderate skin irritation after ESWT. In the radiotherapy group average the
age-corrected constant score improved from 47.6 through 79.5 points to 87.4
points. In the ESWT group it rose from 50.1 points before ESWT to 91.4 points
after 12 weeks and 97.8 after 52 weeks. CONCLUSION: No statistically significant
differences were proven between ESWT and radiotherapy. ESWT appears to be
equivalent but not superior to radiotherapy in treating chronic supraspinatus
tendinitis syndrome. A comprehensive randomized study is, however, necessary to
ensure the equivalence of ESWT.
Publication Types:
Clinical Trial
Evaluation Studies
Randomized Controlled Trial
PMID: 12122787 [PubMed - indexed for MEDLINE]
5: J Shoulder Elbow Surg. 2002 Mar-Apr;11(2):101-7.
Arthroscopic versus open acromioplasty: a prospective, randomized, blinded
study.
Spangehl MJ, Hawkins RH, McCormack RG, Loomer RL.
Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
The purpose of this study is to determine whether arthroscopic acromioplasty is
equivalent or superior to open acromioplasty, in a prospective, randomized,
controlled, blinded clinical trial. Seventy-one patients with a clinical
diagnosis of impingement syndrome were randomized to arthroscopic or open
acromioplasty. Nine were excluded because of full-thickness rotator cuff tears
diagnosed after randomization. Sixty-two patients (49 men and 13 women) with a
minimum follow-up of 12 months (mean, 25 months) were included. The patient
groups were virtually identical with regard to duration of symptoms, shoulder
functional demands, age, sex, hand dominance, mechanism of onset, range of
motion, strength, joint laxity, and the presence of a compensation claim.
Patients were prospectively randomized to arthroscopic or open acromioplasty
after stratification for age (>50 years),associated ligamentous laxity, and the
presence of an ongoing compensation claim. The main outcome measure was visual
analog scales for pain and function. Also recorded were UCLA shoulder scores and
visual analog scales for postoperative improvement, patient satisfaction, and a
variety of clinical measures. An independent blinded examiner assessed all
patients. There was no significant difference between open and arthroscopic
acromioplasty in visual analog scales for postoperative improvement (P =.30),
patient satisfaction (P =.94), UCLA shoulder score (P =.69), or strength (P
=.62); however, open was superior to arthroscopic acromioplasty for pain and
function (P =.01). Overall, 67% of patients had a good or excellent result. This
increased to 87% when unsettled compensation claims were excluded. Repeat (open)
acromioplasty was performed in 5 patients in the unsuccessful arthroscopic group
without improvement. Open acromioplasty was equivalent to arthroscopic
acromioplasty for UCLA scores and patient satisfaction. For pain and function,
both gave significant improvement but the open technique may be superior.
Unsettled compensation is a predictor of poor outcome.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 11988719 [PubMed - indexed for MEDLINE]
6: Z Orthop Ihre Grenzgeb. 2001 Sep-Oct;139(5):397-402.
[Comparison of extracorporeal shockwave therapy (ESWT) with roentgen irradiation
in supraspinatus tendon syndrome--a prospective randomized single-blind parallel
group comparison]
[Article in German]
Haake M, Sattler A, Gross MW, Schmitt J, Hildebrandt R, Muller HH.
Orthopadische Klinik, Philipps-Universitat Marburg. haake2@mailer.uni-marburg.de
AIM: Extracorporal shock wave therapy (FSWT) is applied in the case of
supraspinatus tendinitis if conservative therapies have failed. So far there has
been no controlled study comparing the effectiveness of ESWT with an established
conservative method of therapy such as X-ray stimulation radiotherapy. METHOD:
Thirty patients with chronic supraspinatus tendinitis were admitted into the
prospective randomised study. After randomisation, the patients were treated
either three times with 2000 pulses (energy flux density ED+ 0.33 mJ/mm2) with a
Storz Minilith SL1 after one week, or with X-ray stimulation radiotherapy with 6
x 0.5 Gy on the ICRU reference point (1 neutral fraction/day) with cobalt 60
gamma rays. Primary endpoint was the age-corrected constant score. RESULTS: In
the ESWT group the average age-corrected constant score rose from 50.1 points
before ESWT to 91.5 points after 12 weeks and to 97.8 after 52 weeks. In the
radiotherapy group it improved from 47.6 through 79.5 points to 87.4 points.
CONCLUSION: No statistically significant differences were proven between ESWT
and radiotherapy. ESWT appears to be at least equivalent to radiotherapy in
treating chronic supraspinatus tendinitis syndrome and can avoid a dose of
radiation for patients and staff. A comprehensive randomised study is, however
necessary to ensure the equivalence of ESWT.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 11605290 [PubMed - indexed for MEDLINE]
7: Int Orthop. 2000;24(1):40-2.
Local anaesthetic injection with and without corticosteroids for subacromial
impingement syndrome.
Plafki C, Steffen R, Willburger RE, Wittenberg RH.
Department of Orthopedic Surgery, Duesseldorf, Germany. christian.plafki@gmx.de
Fifty patients with impingement syndrome refractory to long-term conservative
treatment were randomized to three treatment groups. All patients received an
injection of 10 ml 0.5% bupivacaine, in group 1 without corticosteroid, in group
2 with crystalline corticosteroid and in group 3 with lipoid corticosteroid.
Treatment in group 1 had to be stopped because of inefficacy. In groups 2 and 3
favorable results were achieved in 19 out of 40 patients.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 10774861 [PubMed - indexed for MEDLINE]
8: J Orthop Sports Phys Ther. 2000 Mar;30(3):126-37.
Comparison of supervised exercise with and without manual physical therapy for
patients with shoulder impingement syndrome.
Bang MD, Deyle GD.
Department of Medicine, Kaiser Permanente Medical Center, Vallejo, Calif. 94590,
USA. Mbang96@aol.com
STUDY DESIGN: A prospective randomized clinical trial. OBJECTIVE: To compare the
effectiveness of 2 physical therapy treatment approaches for impingement
syndrome of the shoulder. BACKGROUND: Manual physical therapy combined with
exercise is a commonly applied but currently unproven clinical treatment for
impingement syndrome of the shoulder. METHODS AND MEASURES: Thirty men and 22
women (age 43 years +/- 9.1) diagnosed with shoulder impingement syndrome were
randomly assigned to 1 of 2 treatment groups. The exercise group performed
supervised flexibility and strengthening exercises. The manual therapy group
performed the same program and received manual physical therapy treatment. Both
groups received the selected intervention 6 times over a 3-week period. The
testers, who were blinded to group assignment, measured strength, pain, and
function before treatment and after 6 physical therapy visits. Strength was a
composite score of isometric strength tests for internal rotation, external
rotation, and abduction. Pain was a composite score of visual analog scale
measures during resisted break tests, active abduction, and functional
activities. Function was measured with a functional assessment questionnaire.
The visual analog scale used to measure pain with functional activities and the
functional assessment questionnaire were also measured 2 months after the
initiation of treatment. RESULTS: Subjects in both groups experienced
significant decreases in pain and increases in function, but there was
significantly more improvement in the manual therapy group compared to the
exercise group. For example, pain in the manual therapy group was reduced from a
pretreatment mean (+/- SD) of 575.8 (+/- 220.0) to a posttreatment mean of 174.4
(+/- 183.1). In contrast, pain in the exercise group was reduced from a
pretreatment mean of 557.1 (+/- 237.2) to a posttreatment mean of 360.6 (+/272.3). Strength in the manual therapy group improved significantly while
strength in the exercise group did not. CONCLUSION: Manual physical therapy
applied by experienced physical therapists combined with supervised exercise in
a brief clinical trial is better than exercise alone for increasing strength,
decreasing pain, and improving function in patients with shoulder impingement
syndrome.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 10721508 [PubMed - indexed for MEDLINE]
9: J Shoulder Elbow Surg. 1999 Mar-Apr;8(2):102-11.
Arthroscopic surgery versus supervised exercises in patients with rotator cuff
disease (stage II impingement syndrome): a prospective, randomized, controlled
study in 125 patients with a 2 1/2-year follow-up.
Brox JI, Gjengedal E, Uppheim G, Bohmer AS, Brevik JI, Ljunggren AE, Staff PH.
Department of Phys Med Rehab, Ullevaal Univ Hosp, Norway.
The effectiveness of arthroscopic surgery, supervised exercises, and placebo was
compared in 125 patients with rotator cuff disease (impingement syndrome stage
II) in a randomized clinical trial. The median age was 48 years, and the median
duration of complications was 1 to 2 years. The treatments were arthroscopic
subacromial decompression performed by 2 experienced surgeons, an exercise
regimen supervised for 3 to 6 months by 1 experienced physiotherapist, or 12
sessions of detuned soft laser (placebo) for 6 weeks. The criterion for success
was a Neer shoulder score > 80. Fifteen (50%) and 11 (22%) of the patients
randomized to placebo and exercises, respectively, had surgery during the 2
1/2-year follow-up period and were classified as having failure with the
treatments. The success rate was higher (P < .01) for patients randomized to
surgery (26 of 38) and exercises (27 of 44) compared with the placebo group (7
of 28). The odds ratio for success after surgery compared with exercises was 1.5
(95% confidence interval 0.6 to 3.7; P = .49). Including all patients who
underwent operation, the success rate in those not on sick leave (19 of 21)
before surgery was higher compared with those on sick leave (18 of 36) (adjusted
odds ratio 5.6 [1.2 to 29.2]). Similar results were observed for patients not
receiving versus those receiving regular pain medication before surgery
(adjusted odds ratio 4.2 [1.2 to 15.8]).
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 10226960 [PubMed - indexed for MEDLINE]
10: J Shoulder Elbow Surg. 1999 Mar-Apr;8(2):99-101.
Self-training versus physiotherapist-supervised rehabilitation of the shoulder
in patients treated with arthroscopic subacromial decompression: a clinical
randomized study.
Anderson NH, Sojbjerg JO, Johannsen HV, Sneppen O.
Department of Orthopaedics, University Hospital of Aarhus, Denmark.
In a controlled clinical prospective study, 43 consecutive patients (43
shoulders) with subacromial impingement resistant to conservative therapy and
without full-thickness rotator cuff tears underwent arthroscopic subacromial
decompression. The patients were randomized to either self-training or
physiotherapist-guided rehabilitation for immediate postoperative
rehabilitation. Postoperative follow-up was performed by an independent observer
after 3, 6, and 12 months. With the use of the Constant score for evaluation of
functional outcome, patients training themselves improved from a mean 53 points
(range 26 to 81 points) to a mean 79 points (range 45 to 100) points after 12
months. Physiotherapist-supervised patients improved from a mean 54 points
(range 20 to 90 points) to a mean 80 points (range 40 to 100 points). The
self-training patients returned to work after a mean 8.5 weeks (range 1 to 14
weeks), whereas the physiotherapist-supervised patients returned to work after a
mean 8 weeks (range 3 to 13 weeks). No statistical difference was found between
the 2 rehabilitation methods. This study was unable to show any beneficial
effect of physiotherapist-supervised rehabilitation after arthroscopic
subacromial decompression of the shoulder.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 10226959 [PubMed - indexed for MEDLINE]
11: Scand J Rehabil Med. 1998 Dec;30(4):253-62.
The subacromial impingement syndrome. A study of results of treatment with
special emphasis on predictive factors and pain-generating mechanisms.
Rahme H, Solem-Bertoft E, Westerberg CE, Lundberg E, Sorensen S, Hilding S.
Department of Orthopedics, Central Hospital, Vasteras, Sweden.
Forty-two patients with subacromial impingement syndrome entered a randomized
prospective study comparing open anterior acromioplasty with a physiotherapy
regime. The criterion for a successful outcome of treatment was a reduction of
the initial pain score of more than 50% using the visual analogue scale (VAS)
technique. The evaluation was performed by an independent observer. At the
6-month follow-up, treatment in the surgical group had been successful in 12/21
(57%) patients versus 6/18 (33%) in the physiotherapy group. A one-year
evaluation revealed 16/21 (76%) "successes" in the surgical group. A direct and
unbiased comparison with the physiotherapy group was not possible at one year,
since 13 patients chose surgery after initial physiotherapy. However, in "an
intention to treat" analysis outcome at one year was significantly better in
those randomized to surgery. We found two standardized, composite, active
movements--the "Pour out of a Pot" manoeuvre requiring the emptying of a pot of
water, and the "Hand in Neck" manoeuvre--to be of predictive value for the
outcome of surgery. When combining three pain-related variables into a criterion
for prediction of success, a sensitivity of 78% (p < 0.02) and a specificity of
90% (p < 0.03) were attained. We advance the hypothesis that pain in the
impingement syndrome is mainly elicited by comparison of the subacromial bursa.
In some patients a traction-responsive pain generator in the supraspinatus
tendon may be present as well.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 9825390 [PubMed - indexed for MEDLINE]
12: J Orthop Sports Phys Ther. 1998 Jul;28(1):3-14.
The effect of joint mobilization as a component of comprehensive treatment for
primary shoulder impingement syndrome.
Conroy DE, Hayes KW.
Northwestern University Medical School, Programs in Physical Therapy, Chicago,
IL, USA.
Primary shoulder impingement syndrome is a common shoulder problem which, if
treated ineffectively, can lead to more serious pathology and expensive
treatment. This study examined whether subjects receiving joint mobilization and
comprehensive treatment (hot packs, active range of motion, physiologic
stretching, muscle strengthening, soft tissue mobilization, and patient
education) would have improved pain, mobility, and function compared with
similar patients receiving comprehensive treatment alone. Subjects were eight
men and six women (mean age = 52.9 years) with primary shoulder impingement
syndrome (superolateral shoulder pain, decreased active humeral elevation,
limited overhead function). Following random assignment to experimental (N = 7)
and control groups (N = 7), three blinded evaluators tested 24-hour pain (visual
analog scale), pain with subacromial compression test (visual analog scale),
active range of motion (goniometry), and function (reaching forward, behind the
head, and across the body in an overhead position) before and after nine
treatments. One-tailed analyses of covariance (baseline values as covariates)
showed that the experimental group had less 24-hour pain and pain with
subacromial compression test but no differences in range of motion and function
(Mann-Whitney U) compared with controls. The experimental group improved on all
variables, while the control group improved only on mobility and function
(one-tailed, paired t tests; Wilcoxon matched pairs). Age, side of dominance,
duration of symptoms, treatment attendance, exercise quality, and adherence had
no effect on the outcomes. Results may be affected by inadequate sample size,
minimal capsular tightness, insensitive functional scale, nonspecific motion
measurements, position at which mobilization treatment was given, or a strong
effect of comprehensive treatment. Mobilization decreased 24-hour pain and pain
with subacromial compression test in patients with primary shoulder impingement
syndrome, but larger replication studies are needed to assess more clearly
mobilization's influence on motion and function.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 9653685 [PubMed - indexed for MEDLINE]
13: J Bone Joint Surg Am. 1996 Nov;78(11):1685-9.
Efficacy of injections of corticosteroids for subacromial impingement syndrome.
Blair B, Rokito AS, Cuomo F, Jarolem K, Zuckerman JD.
The Shoulder Institute, the Hospital for Joint Diseases, New York City, N.Y.
10003, USA.
A prospective, randomized, controlled, double-blind clinical study was performed
to determine the short-term efficacy of subacromial injection of corticosteroids
for the treatment of subacromial impingement syndrome. Forty patients were
randomized to receive either six milliliters of 1 per cent lidocaine without
epinephrine (the control group) or two milliliters containing forty milligrams
of triamcinolone acetonide per milliliter with four milliliters of 1 per cent
lidocaine without epinephrine (the corticosteroid group). The patients were
re-examined serially until completion of the study. Nineteen patients, whose
mean age was fifty-six years (range, thirty-two to eighty years), were
randomized to the corticosteroid group, and twenty-one patients, whose mean age
was fifty-seven years (range, thirty-two to eighty-one years), were randomized
to the control group. The mean duration of symptoms before the injection was
eight months for both groups. Eighteen patients in the corticosteroid group and
nineteen patients in the control group had moderate or severe pain before the
injection. At the most recent follow-up evaluation, at a mean of thirty-three
weeks for the corticosteroid group and twenty-eight weeks for the control group,
three patients in the corticosteroid group had moderate or severe pain, compared
with fifteen patients in the control group. The mean active range of forward
elevation and external rotation improved by 24 and 11 degrees, respectively, for
the corticosteroid group and by 10 and 5 degrees, respectively, for the control
group. We concluded that subacromial injection of corticosteroids is an
effective short-term therapy for the treatment of symptomatic subacromial
impingement syndrome. The use of such injections can substantially decrease pain
and increase the range of motion of the shoulder.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 8934482 [PubMed - indexed for MEDLINE]
14: Rehabilitation (Stuttg). 1996 Aug;35(3):176-8.
[Long-term therapeutic effect of different intra-articular injection treatments
of the painful shoulder--effect on pain, mobility and work capacity]
[Article in German]
Strobel G.
Klinik im Schlosspark, Schlossparkkliniken Bad Waldsee.
In two randomized patient groups with painful shoulder syndrome and impingement,
pain, mobility and working capacity were investigated some 14, 90 and 360 days
after a single injection of either Mepivacain Hydrochloride alone or in
combination with 20 mg of Triamcinolone Hexaacetonide. Superiority of the
combination therapy was found to be statistically significant with regard to
pain levels, and very likely with regard to shoulder mobility as well as
restoration or preservation of working capacity.