Haahr, Ann Rheum Dis 2005 - Exercises versus Arthroscopic Decompression in Patients with Subacromial Impingement: A Randomised, Controlled Study in 90 Cases with a One Year Follow Up - Article Summary

Exercises versus Arthroscopic Decompression in Patients with Subacromial Impingement: A Randomised, Controlled Study in 90 Cases with a One Year Follow Up

Haahr, Andersen, et al.·Ann Rheum Dis·2005·261 citations·RCT

Purpose

To compare the effect of graded physiotherapeutic training of the rotator cuff versus arthroscopic subacromial decompression in patients with subacromial impingement.

Methods

Randomised controlled trial with 12 months' follow up in a hospital setting.
90 consecutive patients aged 18 to 55 years were enrolled.
Symptom duration was between 6 months and 3 years.
All fulfilled a set of diagnostic criteria for rotator cuff disease, including a positive impingement sign.
Patients were randomised either to arthroscopic subacromial decompression, or to physiotherapy with exercises aiming at strengthening the stabilisers and decompressors of the shoulder.
Outcome was shoulder function as measured by the Constant score and a pain and dysfunction score. 'Intention to treat' analysis was used, with comparison of means and control of confounding variables by general equation estimation analysis.

Results

Of 90 patients enrolled, 84 completed follow up (41 in the surgery group, 43 in the training group).
The mean Constant score at baseline was 34.8 in the training group and 33.7 in the surgery group.
After 12 months the mean scores improved to 57.0 and 52.7, respectively, the difference being non-significant.
No group differences in mean pain and dysfunction score improvement were found.

Conclusions

Surgical treatment of rotator cuff syndrome with subacromial impingement was not superior to physiotherapy with training. Further studies are needed to qualify treatment choice decisions, and it is recommended that samples are stratified according to disability level.

Supplemental

Exercises versus Arthroscopic Decompression in Patients with Subacromial Impingement: A Randomised, Controlled Study in 90 Cases with a One Year Follow Up.