Treatment of Impingement Syndrome: A Systematic Review of the Effects on Functional Limitations and Return to Work

Abstract

The goal of this systematic review is to evaluate the effectiveness of different treatments for impingement syndrome and rotator cuff tear on the improvement in functional limitations and concomitant duration of sick leave. A systematic search for clinical trials or controlled studies was conducted with the following text words: should*, rotator cuff, impingement, work, sick leave, disabilit*, function*. Nineteen articles were included in this review. For functional limitations, there is strong evidence that extracorporeal shock-wave therapy is not effective, moderate evidence that exercise combined with manual therapy is more effective than exercise alone, that ultrasound is not effective, and that open and arthroscopic acromioplasty are equally effective on the long term. For all other interventions there is only limited evidence. We found many studies using range of motion and pain as outcome measures but functional limitations were less often used as an outcome measure in this type of research. Duration of sick leave was seldom included as an outcome measure.

Comparing of the Efficacy and Effectiveness of Isokinetic Exercise, Laser, Pseudoiontophoresis and Iontophoresis Treatments According to the Stage in Treatments of Subacromial Impingement Syndrome

“…SSS tedavisi ile ilgili 19 klinik çalışmayı derlemişler; ekstrakorporeal şok-dalga tedavisinin etkisiz, egzersiz ve manuel terapi kombinasyonunun sadece egzersiz tedavisine göre daha başarılı olduğunu, açık ve artroskopik akromiyoplastinin uzun dönemde egzersiz tedavisi ile eşit etkili olduğunu bulmuşlardır. 21 Haahr ve Ostergaard'ın yaptığı bir çalışmada; SSS tanısı almış 84 hasta randomize olarak artroskopik dekompresyon cerrahisi ve fizyoterapi + egzersiz grubuna ayrılmış, egzersiz olarak omuz stabilizatör ve elevatörlerine germe egzersizleri uygulanmıştır. On iki ay takipten sonra her iki grupta da CS'de anlamlı düzelme olmuş fakat gruplar arasında fark saptanmamıştır.…”

Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions

“…Their results regarding laser therapy also paralleled ours in that it was more effective than placebo for AC. 14 For SIS, 2 reviews 95,96 reported that MT combined with exercise was effective. Bronfort et al 20 concluded that combining MT with medical care was beneficial, and another review 97 found evidence to suggest massage was superior to no treatment.…”

“…Our results contrasted with several reviews that reported that passive therapies such as LLLT and PEMF were not effective or that results were inconclusive for the treatment of RCs, AC, and SIS. 14,64,95,98 Additionally, 1 review determined that the evidence for MT was conflicting for the treatment of SIS and SP and that it was not more effective when compared with other interventions for AC. 97 Another review reported MT was inconclusive but favorable for RCs.…”

Effectiveness of low-level laser therapy in patients with subacromial impingement syndrome: a randomized, placebo controlled, prospective study

“…The incidence is higher in women and in people aged over 45 years (1) . The most frequent cause of shoulder pain is subacromial impingement syndrome (SIS) (2) which is caused by compression of the rotator cuff, long head of the biceps tendon, and subacromial bursa between the humerus and coracoacromial arch as a result of an intrinsic or an extrinsic mechanism (3) . Treatment of SIS is primarily conservative, including analgesic and anti-inflammatory drugs, corticosteroid injections, and occupational and physiotherapy interventions (4) .…”