This randomised controlled trial compared arthroscopic subacromial decompression against supervised graded exercise therapy for subacromial impingement. 90 patients aged 18 to 55 with 6 months to 3 years of symptoms were enrolled. The primary outcome was shoulder function by Constant score at 12 months.
When a patient with stage II subacromial impingement asks whether surgery will help more than physical therapy, this trial says no at one year. Both arms improved by roughly 20 Constant points, and the difference was not significant even after adjusting for confounders.
The practical rule: start with a structured program strengthening the periscapular stabilisers and rotator cuff depressors before offering arthroscopic decompression. Watch the crossover data closely. Patients who failed exercise and then had surgery did not catch up, which argues against surgery as an automatic salvage.
Ap. Note the limitations that temper the conclusion: assessors were not blinded, baseline scoring occurred after randomisation, and the actual variability was wider than planned, reducing the study to detecting only a 13-point difference. The authors themselves became more reluctant to recommend surgery for stage II impingement.
This randomised controlled trial compared arthroscopic subacromial decompression against supervised graded exercise therapy for subacromial impingement. 90 patients aged 18 to 55 with 6 months to 3 years of symptoms were enrolled. The primary outcome was shoulder function by Constant score at 12 months.
When a patient with stage II subacromial impingement asks whether surgery will help more than physical therapy, this trial says no at one year. Both arms improved by roughly 20 Constant points, and the difference was not significant even after adjusting for confounders.
The practical rule: start with a structured program strengthening the periscapular stabilisers and rotator cuff depressors before offering arthroscopic decompression. Watch the crossover data closely. Patients who failed exercise and then had surgery did not catch up, which argues against surgery as an automatic salvage.
Ap. Note the limitations that temper the conclusion: assessors were not blinded, baseline scoring occurred after randomisation, and the actual variability was wider than planned, reducing the study to detecting only a 13-point difference. The authors themselves became more reluctant to recommend surgery for stage II impingement.