Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?

Abstract

Background and purpose — Shoulder impingement syndrome is common, but treatment is controversial. Arthroscopic acromioplasty is popular even though its efficacy is unknown. In this study, we analyzed stage-II shoulder impingement patients in subgroups to identify those who would benefit from the operation.Patients and methods — In a previous randomized study, 140 patients were either treated with a supervised exercise program or with arthroscopic acromioplasty followed by a similar exercise program. The patients were followed up at 2 and 5 years after randomization. Self-reported pain was used as the primary outcome measure.Results — Both treatment groups had less pain at 2 and 5 years, and this was similar in both groups. Duration of symptoms, marital status (single), long periods of sick leave, and lack of professional education appeared to increase the risk of persistent pain despite the treatment. Patients with impingement with radiological acromioclavicular (AC) joint degeneration also had more pain. The patients in the exercise group who later wanted operative treatment and had it did not get better after the operation.Interpretation — The natural course probably plays a substantial role in the outcome. Based on our findings, it is difficult to recommend arthroscopic acromioplasty for any specific subgroup. Regarding operative treatment, however, a concomitant AC joint resection might be recommended if there are signs of AC joint degeneration. Even more challenging for the development of a treatment algorithm is the finding that patients who do not recover after nonoperative treatment should not be operated either.

Do intra-articular pathologies accompanying symptomatic acromioclavicular joint degeneration vary across age groups?

“…[9,10] In the literature, it was reported that AC joint injection should be ultrasound-guided as in the GH joint since the accuracy rate in blind injections is 40-72%. [11][12][13][14][15] Resection can be performed with a direct view of the joint space with open DCR; however, AC joint instability and persistent pain associated with poor functional outcome can occur due to damage in deltoid fascia, superior AC ligament, and capsule. [16,17] Better results can be achieved by preserving these structures with arthroscopic DCR.…”

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

“…Follow-up periods in future trials need to be longer to learn more about the course of SIS. 63 In our meta-analysis 137 studies assessed patients within 2 weeks after end of treatment, 54 studies at 6 weeks, 52 studies at the end of 3 months, 24 studies up to 6 months, whereas only 21 studies had a follow-up longer than 6 months, and in 3 studies the length of follow-up was unclear. 51 64 65 Not all interventions were compared against validated sham interventions or placebo.…”

Is arthroscopic decompression better than conservative management for shoulder impingement? A systematic review and meta-analysis

“…A similar FIMPACT study 4 conducted by Paavola et al yielded the same conclusion. Ketola et al conducted a study [24][25][26][27][28] to compare arthroscopic acromioplasty with conservative treatment for shoulder impingement and the follow-up time lasted for more than 10 years, the results revealed that there were no significant differences in the changes of the rotator cuff between the two groups at the five-year follow-up, and they also conducted a detailed subgroup analysis, while no significant difference was found in the subgroup analysis either. The study 21 conducted by Rahme et al compared open surgery with conservative treatment for shoulder impingement, and the results showed that open surgery achieved better clinical results than conservative treatment, and they believed that shoulder impingement was caused by subacromial capsular compression, which was in conflict with previous studies.…”

“…By carefully reading the full text, it was found that: 3 articles 16-18 were just study protocol, 1 article 6 we couldn't extract the data we need, 2 article 19,20 were not randomized controlled trial, 3 articles [21][22][23] were based on the comparison of other surgical method and conservative management. 11 studies met our inclusion and exclusion criteria, and among these studies, 5 studies [24][25][26][27][28] published by Ketola et al described the same clinical study and the follow-up time of these studies all belonged to our long-term subgroup, so we only included as one. 7 eligible RCTs 4,5,28-32 were included eventually in our meta-analysis.…”