Table 3

 Description of studies included in the systematic review

Ainsworth (2006)2410 patientsClinical inclusion:Neurological abnormality affecting the shoulder complexDefined programme involving:
Mean age 76 yearsall or some ofPotentially operable RC tearsActive anterior deltoid strengthening, scapular exercises, patient education, adaptation, proprioception, home programme
(range 70-83 years)positive humeral thrust on elevation,Patients involved in industrial claim or litigation1 x 30 minute treatment each week for 4 weeks
6 femalegross weakness and wasting of the supraspinatus and infraspinatus, infraspinatus lag, rupture of long head bicepsThen at 2–3 weekly intervals
4 maleUltrasound confirmation of massive rotator cuff tear (defined as leading edge of tear retracted past glenoid margin)Duration and number of treatments not stated
Not stated
Duration of symptoms prior to treatment:
Not stated
Bokor et al (1993)2553 patients from initial group of 80 patients.Clinical inclusion:Previous or subsequent surgery on the involved shoulderNSAIDs
Mean age at onset 62.2 yearsPain and / weaknessStrengthening and stretching
(range 45–83 years)Nonoperative course of treatment chosen by patient and clinicianCorticosteroid injections (16 shoulders)
13 femaleArthrogram confirmation of rotator cuff tear15 of these continued to have pain at final review
40 male
Trauma 40 patients
Duration of symptoms prior to treatment:
39 no history of symptoms prior to onset.
< 3 months – 28 patients
3–6 months – 9 patients
> 6 months – 16 patients
Goldberg et al (2001)2646 patientsClinical inclusion:Workers compensation claimEducation
Mean age 65 yearsNone statedPrevious surgeryHome strengthening and stretching programme
(SD+11 years)Elective nonoperative management.Strengthening involving: rotator cuff specific exercises,
24 femaleUltrasound, MRI or arthrogram confirmation of non-acute full thickness rotator cuff tearProgressive supine press
22 maleStretching involving:
Onset:flexion, external and internal rotation and cross-body adduction
Not stated
Duration of symptoms prior to treatment:
No acute tears (time not specified)
Hawkins and Dunlop (1995)2733 patients available for follow-up (from initial group of 50)Clinical inclusion:Supervised exercises over a 4-month period, and home programme, including:
Mean age 59.6 yearsNot statedInternal and external rotation (with rubber tubing), short and long arc active flexion-extension exercises,
6 femaleClinical assessment:Scapular retraction, supraspinatus drill, diagonal proprioneuromuscular facilitation patterns with weights
27 maleMuscle wastingStrengthening exercises and proprioceptive patterning
Onset:‘Pop-eye’ deformity
Traumatic 21Active and passive movement
Non-traumatic 12Drop arm sign
Duration of symptoms prior to treatment:Strength tests
1 month to 30 yearsDouble contrast arthrogram confirmation of rotator cuff tear
Heers et al (2005)2834 patients recruitedClinical inclusion:X-ray or MRI finding of subacromial spurHome-based graduated exercise programme involving: 3 warm-up exercises, 4 stretching exercises, 5 strengthening exercises
23 femaleNeer Impingement SignYounger than 40 yearsThe home programme required 40 minutes per day for 12 weeks
13 maleand / orOlder than 70 years
Mean age 60.4 years (range 44–69)Hawkins and Kennedy TestPrevious surgery
Onset:Clinical assessmentNo analgesia permitted during 12-week programme
Not statedRange of movement:
Duration of symptoms prior to treatment:external rotation, flexion, abduction
Group I: 30.4 (SD = 34.5) monthsUltrasound
Group II: 28.8 (SD = 23.9) months
Group III: 71.0 (SD = 48.3) months
Itoi and Tabata (1992)29114 patients (124 shoulders) recruitedClinical inclusion:Fracture or fracture dislocation of shoulderVarious combinations of: rest, NSAIDs, steroid injection (repeated to a maximum of 4 times)
55 FemaleNone statedAfter the symptoms had subsided: active and passive range of motion, and muscle strengthening exercises started
59 MaleClinical assessment:Mean treatment period: 26 months (range 1–83 months)
Onset:Impingement test
Not statedPalpation tenderness
Duration of symptoms prior to treatment:Muscle atrophy
Acute tears (<3 weeks) [15 shoulders]Night pain
3 weeks to 3 months [19 shoulders]Motion pain
3 months to 12 months [19 shoulders]Arthrogram confirmation of rotator cuff tear
> 12 months [9 shoulders]6 patients with traumatic anterior dislocation of the shoulder were also included
Koubaa et al (2005)30Case series of 24 patientsClinical inclusion:Analgesics for mild pain, analgesics and NSAID (Piroxicam 20 mg/day for 14 days) for stronger pain
15 femaleNone statedCorticosteroid injection if medications did not reduce pain
9 maleClinical assessmentWhen pain was controlled rehabilitation programme commenced (3 times per week for 2 months)
Mean age 59 years (range 44–83 years)Pain at restThis included:
Onset:Pain with activityPulsed ultrasound for 10 minutes and cervical massage prior to each treatment
Chronic degenerative changesPain at nightPassive range of movement exercises.
Duration of symptoms prior to treatment:Range of movementHumeral head depressor exercises (pectoralis major and latissimus dorsi).
Mean 9.1 (SD = 12.3) months (range 3–32 months)Impairment (VAS)Abduction exercises
Subjective benefit rated as: effective or very effective, little effect, not effectiveProprioceptive exercises
Returned to work on other functional activitiesEducation (avoid shoulder flexion and sustained or repetitive overhead activities).
All patients had refused surgical repairBiofeedback exercises
Palmer (1998)31Single case studyClinical inclusion:None statedActive water-based exercises including stretching and strengthening and swimming for 3.5 months, divided into two phases
1 femaleNone statedPhase I: Water-based progressive resistance exercises, range of movement exercises, breast-stroke
78 years(Recommendation for surgery following medical examination)Phase II: Overhead curl
Onset:MRI confirmation of FTT supraspinatusCommenced at week 8
Head-on motor vehicle collisionPatient seen on 10 occasions in clinic and continued programme at home in own therapeutic pool
Duration of symptoms prior to treatment:
6.5 months
Piccoli and Hasson (2004)32Single case studyClinical inclusion:Physical therapy 3 times per week for 7 weeks (19 visits)
1 femaleFull can testPhase I
Age 76 yearsDrop arm testPulsed ultrasound, isometric shoulder exercises, active assisted movements, isokinetic exercises, scapular exercises, home programme and ice
Onset:Neer signPhase II
FallClinical assessment:Isokinetic exercises, scapular exercises, active assisted exercises against gravity, active exercises, free weights, resistance tubing exercises
Duration of symptoms prior to treatment:Forward head posturePhase III
1 weekScapular symmetryFunctional exercises, proprioceptive neuromuscular facilitation.
Range of movement
VAS (pain)
Shoulder muscle strength
MRI confirmation of FTT supraspinatus (5.0 cm)
Yamada et al (2000)33Case series of 13 patients choosing conservative treatmentClinical inclusion:Weeks 1–3 sling for comfort
5 femaleNot statedCS injection (1–2/week; up to 15 injections in total)
9 maleArthrographyHotpacks
Mean age 70 years (range 55–81 years)Passive range of movement for flexion and external rotation
Onset:Rotator cuff strengthening exercises
Not statedInjection, heat, exercise, passive movement
Duration of symptoms prior to treatment:
Mean 44 months (range 12 months to 11 years)