Subacromial Impingement Syndrome. A Retrospective Analysis of Long-Term Outcomes of Surgical and Conservative Treatment

Abstract

INTRODUCTION. Subacromial impingement syndrome (SAIS) is one of the most common reasons that makes patients seek treatment for shoulder pain.
 PURPOSE. To assess the effectiveness of surgical and conservative treatment of patients with subacromial impingement syndrome.
 MATERIALS AND METHODS. The clinical results of 48 patients with SAIS stage 1, 2 according to Neer, divided into 3 groups, were analyzed: 1) conservative group without rotator cuff tears (16 patients), 2) conservative group with partial rotator cuff tears (16 patients); 3) surgical group (16 patients). The patients of the conservative groups were treated according to the rehabilitation protocol including myofascial release techniques, physiotherapy, manual therapy, exercises. The patients of the surgical group underwent an arthroscopic subacromial decompression. The follow-up period was at least 24 months. The clinical condition of the patients was assessed using ASES, VAS scales and SANE questionnaire.
 RESULTS. The study did not reveal a statistically significant difference of the surgical and conservative treatment groups according to VAS and ASES. There was a statistically significant difference in the results of the SANE questionnaire (p = 0.008) with better results in the conservative groups. Longer rehabilitation was noted in patients of the surgical group.
 DISCUSSION. Ketola et al. compared clinical results of surgical group of patients who underwent the subacromial decompression and the conservative group who performed the exercises. There was no statistically significant difference found in VAS level results, subjective shoulder function assessment. Paavola et al. have not found statistically significant difference in VAS scale results between surgical group, group of diagnostic arthroscopy and conservative group of patients with rotator cuff tendinopathy.
 CONCLUSION. The conservative treatment of subacromial impingement syndrome with physiotherapy and manual therapy let achieve good and excellent results.