Review article (meta-analysis)Effectiveness of Surgical and Postsurgical Interventions for the Subacromial Impingement Syndrome: A Systematic Review
Section snippets
Search Strategy
To identify relevant systematic reviews and randomized controlled trials (RCTs) on SIS, a search was performed in the Cochrane Library, PubMed, Embase, PEDro, and CINAHL up to February 2009. Key words such as shoulder impingement syndrome and rotator cuff impingement and interventions were included in the literature search (appendix 1).
Inclusion Criteria
Systematic reviews and/or RCTs were considered eligible for inclusion if: (1) the study included patients with SIS, (2) SIS was not caused by an acute trauma or
Study Characteristics
The initial literature search identified 5 reviews via the Cochrane Library, 5 reviews/215 RCTs via PubMed, 21 reviews/193 RCTs via Embase, 141 reviews/RCTs via CINAHL, and 0 reviews/13 RCTs via PEDro were identified. Finally, 1 Cochrane review and 5 RCTs (all found in PubMed) were included. The Cochrane review of Coghlan et al,11 studying the effectiveness of surgery for rotator cuff disease, included 14 trials; 11 (n=611) of these studies reported on SIS (including calcific tendinitis) and
Systematic review
Three trials (n=258) compared either open14 or arthroscopic15, 16 surgery with active nonoperative treatment. The low-quality study of Haahr et al16 (n=90) found no differences between arthroscopic subacromial decompression and a graded physiotherapy strengthening program on the mean change in Constant score at 3, 6, and 12 months. Furthermore, there were no significant differences between the 2 treatment groups for the PRIM score (aggregated pain and dysfunction score used in Projects on
Additional RCT
A low-quality RCT27 compared 2 different physiotherapy protocols in patients (n=33) with SIS who had ASD. A traditional group received active assisted dynamic exercises for the rotator cuff 6 weeks after operation (3 times per day) and strengthening exercises 8 weeks after operation. A progressive group received active assisted ROM exercises 1 day after operation (3 times per day) and strengthening exercises 6 weeks after operation (3 times per day). Both groups showed significant improvements
Discussion
In general, patients failing to respond to conservative treatments are considered for surgery. In the present review no evidence was found for the superiority of subacromial decompression (arthroscopic or open) compared with conservative treatment in the short, mid, and long term. However, our conclusion is based on only 3 low-quality studies that included a small number of patients. Although no significant results were found between surgery and conservative treatment, 1 study16 found better
Conclusions
This review shows that there is no evidence that surgical treatment is superior to conservative treatment or that 1 particular surgical technique is superior to another to treat SIS. Because of lower costs and possibly lower risk of complications, conservative treatment may be preferred to surgery. When choosing surgery, arthroscopic decompression may be preferred because of the faster recovery of ROM and the minimally invasive character of the procedure. Furthermore, early activation
Acknowledgement
We thank M.S. Randsdorp (MR), MD, for her participation in the quality assessment.
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