Treatments for Shoulder Impingement Syndrome

Abstract

Many treatments for shoulder impingement syndrome (SIS) are available in clinical practice; some of which have already been compared with other treatments by various investigators. However, a comprehensive treatment comparison is lacking.Several widely used electronic databases were searched for eligible studies. The outcome measurements were the pain score and the Constant–Murley score (CMS). Direct comparisons were performed using the conventional pair-wise meta-analysis method, while a network meta-analysis based on the Bayesian model was used to calculate the results of all potentially possible comparisons and rank probabilities.Included in the meta-analysis procedure were 33 randomized controlled trials involving 2300 patients. Good agreement was demonstrated between the results of the pair-wise meta-analyses and the network meta-analyses. Regarding nonoperative treatments, with respect to the pain score, combined treatments composed of exercise and other therapies tended to yield better effects than single-intervention therapies. Localized drug injections that were combined with exercise showed better treatment effects than any other treatments, whereas worse effects were observed when such injections were used alone. Regarding the CMS, most combined treatments based on exercise also demonstrated better effects than exercise alone. Regarding surgical treatments, according to the pain score and the CMS, arthroscopic subacromial decompression (ASD) together with treatments derived from it, such as ASD combined with radiofrequency and arthroscopic bursectomy, showed better effects than open subacromial decompression (OSD) and OSD combined with the injection of platelet-leukocyte gel. Exercise therapy also demonstrated good performance. Results for inconsistency, sensitivity analysis, and meta-regression all supported the robustness and reliability of these network meta-analyses.Exercise and other exercise-based therapies, such as kinesio taping, specific exercises, and acupuncture, are ideal treatments for patients at an early stage of SIS. However, low-level laser therapy and the localized injection of nonsteroidal anti-inflammatory drugs are not recommended. For patients who have a long-term disease course, operative treatments may be considered, with standard ASD surgery preferred over arthroscopic bursectomy and the open surgical technique for subacromial decompression. Notwithstanding, the choice of surgery should be made cautiously because similar outcomes may also be achieved by the implementation of exercise therapy.

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

“…However, we cannot exclude that a subset of patients may benefit from surgery. Acupuncture has been recommended as a first choice to be added to exercises for the treatment of early stage shoulder impingement, 13 whereas we did not find enough evidence to make a statement in favour or against acupuncture. Our results for corticosteroid injections were in line with other reviews, 22 24 although we classified the evidence as a lower level of evidence (very low quality compared with moderate to strong in).…”

“…We found positive results for laser, although previous reviews are conflicting about whether laser is 16 or is not 13 57 effective. This might be because previous reviews have included fewer studies, 13 and have not performed a meta-analysis and probably based their statements of evidence on non-significance of the individual trials. 57 Our results for ultrasound therapy, hyaluronate, tape, pulsed electromagnetic field therapy, ECSWT, microwave and platelet-rich plasma support previous reviews.…”

Subacromial decompression surgery for shoulder pain

“…These include the Oxford based CSAW study,4 the Finish FIMPACT trial,5 and a series of systematic reviews 67. These studies show a statistically significant difference in shoulder scores between patients treated surgically (with ASD or control arthroscopy) and patients treated without surgery (usually physical therapy).…”

Efficiency of local hyaluronic acid injections in subacromial impingement syndrome

“…Лечение ССРП основывается на комплексном подходе: использовании противовоспалительных, обезболивающих средств локально и системно, совместно с немедикаментозными подходами -физиотерапией, лечебной физкультурой и реабилитацией [7][8][9].…”