Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study

Abstract

Different exercise programmes are used as first line treatment in patients with subacromial impingement syndrome, but conclusive evidence to support the efficacy for these programmes is lacking. This specific exercise strategy proved effective in improving shoulder function and pain in patients in whom earlier conservative treatment had failed.

A specific exercise strategy reduced the need for surgery in subacromial pain patients

“…These were: shoulder abduction, retraction and elevation, neck retraction and stretch of the upper trapezius and pectoralis major muscles and the exercises were instructed to be pain free. The programmes have previously been described in detail 14. At inclusion, all patients had received a subacromial corticosteroid injection (1 mL triamcinolon 20 mg/mL mixed with 6 mL mepivacain 10 mg/mL).…”

“…A power analysis based on the C-M score24 was calculated for the initial study14 revealing that 82 patients would be required to detect a mean 10-point group difference with a variability of 16 points (β=0.80, two sided α=0.05) 3 9 14. To compensate for dropouts, a further 20 patients were recruited.…”

“…This variability could be due to the different inclusion criteria, treatment and evaluation methods, stressing the need for search of factors influencing treatment response 4 13. We have previously reported successful short-term results after a specific exercise programme with focus on eccentric exercises used for patients on the waiting list for surgery due to subacromial pain 14. Despite the fact that all patients had undergone previous physiotherapy, the majority decided to decline surgery after 3 months of the specific exercises.…”

Novel stretch-sensor technology allows quantification of adherence and quality of home-exercises: a validation study

“…The patient complains that the shoulder still hurts and that the exercise programme he was prescribed had no effect. As the prescribed exercise programme has been shown to be beneficial in reducing shoulder pain,1 the obvious clinical question is why the programme did not work? Adherence to home exercise programmes has often been shown to be insufficient,2–6 and therefore clinicians will always be in doubt whether the exercises were performed as prescribed 7 8…”

“…Recall of compliance9 10 and self-administered training diaries1 11 12 are both limited by recall bias and the effect of trying to please the healthcare provider 13. Video recording of exercises13 is another option; however, it is expensive and limiting as patients are only able to perform the exercises when they are in front of a video camera in their home.…”