Subacromial impingement syndrome: management challenges

Abstract

The painful shoulder is the most common condition seen in specialist shoulder clinics. It is often associated with lack of range of motion and reduced shoulder function. Lack of sleep and difficulties in performing basic daily life activities are common findings. Subacromial Impingement Syndrome (SAIS) has been considered as the most common cause of shoulder pain since it was described in 1852. Charles Neer, in 1972, described the presence of a “proliferative spur and ridge” on the undersurface of the acromion, which needs to be removed to improve the symptoms (acromioplasty). Neer’s “impingement” hegemony was undisputed for at least 30 years. A more extensive knowledge of the pathogenesis of SAIS, however, has led authors to challenge the role of “impingement” in the shoulder pain and the role of surgical intervention. The aim of this review was to understand if there is still a role for surgical decompression in patients with SAIS. A literature review was performed in PubMed, PEDro, Embase, and the Cochrane Central Register of Controlled Trials using impingement, subacromial space, rotator cuff tears, tendinopathy, and tendinitis as key words. Randomized clinical trials (RCTs) with long-term follow-up comparing surgical intervention and conservative treatments in SAIS were preferred; however, prospective articles studying the outcome of surgical decompression and physiotherapy were also included. The majority of the studies showed no difference in the outcome between patients randomized to surgical decompression or conservative management. However, some studies reported better results after surgery, especially in the long term. Interpretation of the results is very difficult as most of the studies are of poor quality and have short follow-up. In our opinion, the type of subacromial lesion needs to be considered; this may offer an explanation to the difference in severity of symptoms and to the varying degrees of response to certain treatments, including surgery. Further studies are mandatory to better understand the role of surgery in SAIS.

Effects of capacitive and resistive electric transfer therapy in patients with painful shoulder impingement syndrome: a comparative study

“… 34 Future randomized controlled trials should examine the combined effects of CARE and exercise, as most studies have shown no difference in outcome between impingement syndrome patients randomized to surgical decompression or conservative management. 35 Thus, it is always desirable to start with conservative rehabilitation treatment, administering surgical treatment only in select cases. The optimal treatment for shoulder impingement syndrome remains unknown, 26 and exercise is still the most important treatment component for this disorder.…”

Temperature and current flow effects of different electrode placement in shoulder capacitive-resistive electric transfer applications: a cadaveric study

“…Impingement syndrome is currently estimated to represent 44-65% of all shoulder pain disorders [1]. The most normal causes of symptoms are extrinsic causes such as work and sport overload [2].…”

Subacromial impingement syndrome: a survey of Italian physiotherapists and orthopaedics on diagnostic strategies and management modalities

“…An interesting element emerges from the results of questions regarding the choices of therapeutic strategies for the patient. There is strong evidence suggesting that physiotherapy treatment is the best conservative strategy initially and for short-term effects [ 4 , 12 , 65 ]. OMPTs from the current study were more aware than orthopaedic surgeons about this, with a statistically significant difference in all three questions dedicated to this topic.…”