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A specific exercise strategy reduced the need for surgery in subacromial pain patients
  1. Hanna C Björnsson Hallgren1,
  2. Theresa Holmgren2,
  3. Birgitta Öberg2,
  4. Kajsa Johansson2,
  5. Lars E Adolfsson1
  1. 1Department of Orthopeadics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
  2. 2Division of Physiotherapy, Institution of Medical and Health Sciences, Linköping University, Linköping, Sweden
  1. Correspondence to Hanna C Björnsson Hallgren, Department of Orthopeadics and Department of Clinical and Experimental Medicine, Linköping University, Linköping SE-581 85, Sweden; hanna.bjornsson.hallgren{at}lio.se

Abstract

Background and purpose A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up. The purposes of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score, rotator cuff status and radiological findings influenced the outcome.

Patients and methods 97 patients on the waiting list for arthroscopic subacromial decompression had been randomised to a specific exercise programme or unspecific exercises (controls). After 3 months of exercises, the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up. 1 year after inclusion or 1 year after surgery, the number of patients who decided to have surgery in each group was compared. The choice of surgery was related to the baseline Constant-Murley score, ultrasound and radiographs taken at inclusion.

Results All patients had improved significantly (p<0.0001) in the Constant-Murley score at the 1-year follow-up. Significantly more patients in the control group decided to have surgery (63%) than those in the specific exercise group (24%; p<0.0001). Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear. Patients with partial tears did not differ from those with intact tendons.

Interpretation The positive short-term results of specific exercises were maintained after 1 year, and this exercise strategy reduces the need for surgery. Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome.

Trial registration number Clinical trials NCT01037673.

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