Elsevier

Journal of Hand Therapy

Volume 17, Issue 2, April–June 2004, Pages 152-164
Journal of Hand Therapy

Scientific/Clinical Articles
Effectiveness of rehabilitation for patients with Subacromial impingement syndrome: a systematic review

https://doi.org/10.1197/j.jht.2004.02.004Get rights and content

Abstract

Prior systematic reviews of rehabilitation for nondescript shoulder pain have not yielded clinically applicable results for those patients with subacromial impingement syndrome (SAIS). The purpose of this study was to examine the evidence for rehabilitation interventions for SAIS. The authors used data source as the method. The computerized bibliographic databases of Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Database of Systematic Reviews were searched from 1966 up to and including October 2003. Key words used were “shoulder,” “shoulder impingement syndrome,” “bursitis,” and “rotator cuff” combined with “rehabilitation,” “physical therapy,” “electrotherapy,” “ultrasound,” “acupuncture,” and “exercise,” limited to clinical trials. Randomized clinical trials that investigated physical interventions used in the rehabilitation of patients with SAIS with clinically relevant outcome measures of pain and quality of life were selected. The search resulted in 635 potential studies, 12 meeting inclusion criteria. Two independent reviewers graded all 12 trials with a quality checklist averaged for a final quality score. The mean quality score for 12 trials was 37.6 out of a possible 69 points. Various treatments were evaluated: exercise in six trials, joint mobilizations in two trials, laser in three trials, ultrasound in two trials, and acupuncture in two trials. The limited evidence currently available suggests that exercise and joint mobilizations are efficacious for patients with SAIS. Laser therapy appears to be of benefit only when used in isolation, not in combination with therapeutic exercise. Ultrasound is of no benefit, and acupuncture trials present equivocal evidence. The low to mediocre methodologic quality, small sample sizes, and general lack of long-term follow-up limit these findings for the development of useful clinical practice guidelines. Further trials are needed to investigate these rehabilitation interventions, the superiority of one intervention over another, and the long-term outcomes of rehabilitation. Moreover, it is imperative that clinical guidelines are developed to indicate those patients who are likely to respond to rehabilitation.

Section snippets

Data source

Bibliographic databases of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials Register were searched from 1966 up to and including October 2003 with the search strategy defined in Table 1. Additionally, the references of all retrieved studies and all relevant conference proceedings were hand-searched. These search strategies yielded 634 eligible studies from the bibliographic databases, and hand-searching resulted in

Results

The 12 included studies were all randomized clinical trials or randomized controlled clinical trials investigating the efficacy of physical interventions for the treatment of patients with SAIS. Two studies48., 49. were combined for this systematic review, because they reported outcomes for the same group of subjects at two different follow-up periods. The mean quality score of included trials was 37.6, ranging from 33.5 to 41 points out of a total of a possible 69 points.

The inclusion criteria

Discussion

This systematic review examined the evidence for the efficacy of rehabilitation interventions for patients with SAIS. The limited evidence currently suggests that exercise, joint mobilization, and laser therapy are effective in decreasing pain and improving function in patients with SAIS. Ultrasound appears to be of no benefit, and acupuncture yielded equivocal findings from two trials. The number of trials examining each specific intervention was limited, and the quality of these trials was

Conclusions

Based on the available evidence for the physical rehabilitation of patients with SAIS, clinical practice guidelines were developed. The current literature most strongly supports the use of therapeutic exercise to strengthen the rotator cuff and scapular muscles and to stretch the soft tissues of the anterior and posterior shoulder. Therapeutic exercise appears to be more effective when combined with joint mobilization techniques focused on the shoulder and upper quarter. A course of therapeutic

Clinical practice recommendations

The following are grade B recommendations derived from level 1 or 2 studies. They are based on the ability of the indicated interventions to improve pain and functional loss or disability levels. These guidelines were devised to assist the clinician in evidence-based clinical decision making in patients with SAIS.

  • 1.

    Therapeutic exercise aimed at stretching the anterior and posterior shoulder girdle, and strengthening of the rotator cuff and scapular stabilizing muscles is recommended over no

References (63)

  • L.A Michener et al.

    A review of self-report scales for the assessment of functional limitation and disability of the shoulder

    J Hand Ther

    (2001)
  • J Kleinhenz et al.

    Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendonitis

    Pain

    (1999)
  • M Urwin et al.

    Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation

    Ann Rheum Dis

    (1998)
  • D.P Pope et al.

    Prevalence of shoulder pain in the community: the influence of case definition

    Ann Rheum Dis

    (1997)
  • A Nygren et al.

    Neck-and-shoulder pain, an increasing problem. Strategies for using insurance material to follow trends

    Scand J Rehabil Med Suppl

    (1995)
  • D.A van der Windt et al.

    Shoulder disorders in general practice: incidence, patient characteristics, and management

    Ann Rheum Dis

    (1995)
  • P Vecchio et al.

    Shoulder pain in a community-based rheumatology clinic

    Br J Rheumatol

    (1995)
  • P.M Ludewig et al.

    Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement

    Phys Ther

    (2000)
  • A.C Lukasiewicz et al.

    Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement

    J Orthop Sports Phys Ther

    (1999)
  • C.S Neer

    Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report

    J Bone Joint Surg [Am]

    (1972)
  • F.H Fu et al.

    Shoulder impingement syndrome. A critical review

    Clin Orthop

    (1991)
  • J.E Budoff et al.

    Debridement of partial-thickness tears of the rotator cuff without acromioplasty. Long-term follow-up and review of the literature

    J Bone Joint Surg [Am]

    (1998)
  • H.K Uhthoff et al.

    The role of the coracoacromial ligament in the impingement syndrome. A clinical, radiological and histological study

    Int Orthop

    (1988)
  • L.U Bigliani et al.

    Subacromial impingement syndrome

    J Bone Joint Surg [Am]

    (1997)
  • J.J Warner et al.

    Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. A study using Moire topographic analysis

    Clin Orthop

    (1992)
  • P.M Ludewig et al.

    Translations of the humerus in persons with shoulder impingement symptoms

    J Orthop Sports Phys Ther

    (2002)
  • N.K Poppen et al.

    Normal and abnormal motion of the shoulder

    J Bone Joint Surg [Am]

    (1976)
  • S Ogata et al.

    Acromial enthesopathy and rotator cuff tear. A radiologic and histologic postmortem investigation of the coracoacromial arch

    Clin Orthop

    (1990)
  • S Vaz et al.

    Subacromial impingement: influence of coracoacromial arch geometry on shoulder function

    Joint Bone Spine

    (2000)
  • M.J Tuite et al.

    Acromial angle on radiographs of the shoulder: correlation with the impingement syndrome and rotator cuff tears

    AJR Am J Roentgenol

    (1995)
  • N Prato et al.

    The anterior tilt of the acromion: radiographic evaluation and correlation with shoulder diseases

    Eur Radiol

    (1998)
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