Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs

Abstract

ObjectiveTo investigate the effectiveness of conservative interventions for pain, function and range of motion in adults with shoulder impingement.DesignSystematic review and meta-analysis of randomised trials.Data sourcesMedline, CENTRAL, CINAHL, Embase and PEDro were searched from inception to January 2017.Study selection criteriaRandomised controlled trials including participants with shoulder impingement and evaluating at least one conservative intervention against sham or other treatments.ResultsFor pain, exercise was superior to non-exercise control interventions (standardised mean difference (SMD) −0.94, 95% CI −1.69 to −0.19). Specific exercises were superior to generic exercises (SMD −0.65, 95% CI −0.99 to −0.32). Corticosteroid injections were superior to no treatment (SMD −0.65, 95% CI −1.04 to −0.26), and ultrasound guided injections were superior to non-guided injections (SMD −0.51, 95% CI −0.89 to −0.13). Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to moderate SMD of −0.29 (95% CI −0.53 to −0.05) compared with placebo. Manual therapy was superior to placebo (SMD −0.35, 95% CI −0.69 to −0.01). When combined with exercise, manual therapy was superior to exercise alone, but only at the shortest follow-up (SMD −0.32, 95% CI −0.62 to −0.01). Laser was superior to sham laser (SMD −0.88, 95% CI −1.48 to −0.27). Extracorporeal shockwave therapy (ECSWT) was superior to sham (−0.39, 95% CI −0.78 to –0.01) and tape was superior to sham (−0.64, 95% CI −1.16 to −0.12), with small to moderate SMDs.ConclusionAlthough there was only very low quality evidence, exercise should be considered for patients with shoulder impingement symptoms and tape, ECSWT, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise.

Does A Group Supervised Shoulder Impingement Class Improve Shoulder Pain, Disability and Generic Health Outcomes? A Summative Service Evaluation

“…These fi ndings fall in line with multiple systematic reviews on MSK conditions responding well to exercise [24,26-28, 107,108]. The fi ndings also align with research on incorporating graduated rotator cuff loading exercises in managing the pain associated with SIS [7,29,30,34,50,109]. The related fi ndings from this research conclude that for SIS pain exercise should be prescribed to all patients.…”

“…There is strong evidence that increasing age is associated with the onset of SIS. Multiple authors concur that those aged 40 and above are more predisposed to developing SIS with those aged between 45 and 64 at more risk [4,[50][51][52]. Neer [53], introduced shoulder impingement as a condition into the literature and described 3 discrete stages affecting under 25 year olds, [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] year olds and over 40 year olds.…”

“…The majority of these studies focus on work related MSK disorders. In the systematic review investigating the effectiveness of conservative interventions in managing SIS by Steuri et al [50], they found the highest incidence and prevalence of the condition in women. Although SIS is often cited as being more prevalent in females there appears to be no research using gender as a predictor of outcome in a SIS group class.…”

“…Those with lower socioeconomic status being more socially and materially deprived have been shown to have poorer health outcomes and reduced response to physiotherapy [66]. Research also indicates both age and gender impacting on common MSK conditions [50]. Poor attendance has been shown to have negative impacts on health outcomes [40].…”

Can the efficacy of subacromial corticosteroid injection be improved using a single-session mobilization treatment in subacromial impingement syndrome? A randomized single-blind controlled trial

“…Subacromial corticosteroid and local anesthetic injections were demonstrated both as a diagnostic and treatment method in SIS [6,7]. They were found to be more effective than placebos, exercises, and physiotherapy in this condition [7,8].…”