Targeted Shoulder Exercises Improve Function and Reduce Surgery for Subacromial Impingement Syndrome
DynaMed Weekly Update - Volume 7, Issue 12
Impingement syndrome is a common shoulder ailment causing pain and loss of function. Usual treatment includes steroid injections and physical therapy, but treatment failure is common, and as a result, nearly a third of patients may eventually have arthroscopic decompression surgery. A recent randomized trial evaluated the efficacy of an exercise program targeted to improve function and reduce the need for surgery in 102 patients with persistent subacromial impingement syndrome that was unresponsive to conservative treatment.
Patients (mean age 52 years) with symptoms for > 6 months who were on a waiting list for arthroscopic surgery were randomized to 1 of 2 supervised exercise programs for 12 weeks. The specific targeted exercise program included eccentric strengthening exercises for the rotator cuff, concentric and eccentric strengthening exercises for the scapula stabilizers and manual mobilization. The control program included general movement exercises for the neck and shoulder. All patients had a subacromial corticosteroid injection 2 weeks prior to initiating exercises, education on ergonomics and posture, individual physical therapy and a home exercise program.
At the end of treatment, the targeted exercise group had a significantly higher rate of patients reporting either recovery or large improvement in symptoms (69% vs. 24%, p < 0.001, NNT 3) (level 1 [likely reliable] evidence). Surgery was performed on 20% of the targeted exercise group vs. 63% of controls (p < 0.001, NNT 3). Targeted exercise was also associated with significantly improved health-related quality of life. There were no significant differences in the use of analgesic or anti-inflammatory drugs (BMJ 2012 Feb 20;344:e787). A data supplement to the article includes instructions for the exercise program (PDF).
For more information, see the Impingement syndrome of rotator cuff topic in DynaMed.