Treatment for shoulder impingement syndrome

Shoulder impingement syndrome (SIS) has been defined by Dong et al (2015) as the compression of the rotator cuff and the subacromial bursa between the acromion and humerus. The authors considered SIS to be one of the most common causes of shoulder pain, cited as a contributing factor to shoulder pain in up to 65% of cases, and is associated with pain localised to the anterolateral acromial area, possible radiation to the lateral mid humerus, night pain and a concurrent general loss of muscle strength.


Dong et al (2015) identified that while many of the common used treatment for SIS have been compared with other treatments by various investigators, a comprehensive treatment comparison is lacking. The authors have recently completed a systematic review and network meta-analysis involving 33 randomized controlled trials involving 2300 patients.


The review found that exercise and other exercise-based therapies are the most important treatment options for SIS patients. The authors concluded that for those patients who seek non-operative treatment option at an early stage of SIS, exercise combined with other physical therapies should be recommended. The authors advised that low-level laser therapy and the localised injection of NSAIDs are not recommended as stand-alone treatment. Interestingly a greater combined effect was found when the localised injection was used alongside exercise based intervention.


For patients with chronic SIS, operative treatment options may be considered. In this case, standard arthroscopic subacromial decompression surgery is a relatively superior option to open subacromial decompression and arthroscopic bursectomy. Notably, however, the decision for operative treatment should be made cautiously because similar outcomes may also be achieved by the implementation of exercise therapy.


The review reinforces the role for specific physical based intervention both in the early phase post onset of symptoms and reinforces it superiority over stand-alone localised injections of NSAIDs. Additionally the study also reinforced the important role of exercise based interventions as a first line treatment option with chronic SIS.
Ref: Wei Dong, MM, Hans Goost, MD, Xiang-Bo Lin, MD, Christof Burger, MD, Christian Paul, MD, Zeng-Li Wang, MM,Tian-Yi Zhang, MM, Zhi-Chao Jiang, MSc, Kristian Welle, MD, and Koroush Kabir, MD Treatments for Shoulder Impingement Syndrome- A PRISMA Systematic Review and Network Meta-Analysis, Medicine 2015 Mar; 94(10): e510.


The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.


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