ARTHROSCOPIC SURGERY COMPARED WITH SUPERVISED EXERCISES IN PATIENTS WITH ROTATOR CUFF DISEASE (STAGE-II IMPINGEMENT SYNDROME)

Objective-To compare the effectiveness of arthroscopic surgery, a supe rvised exercise regimen, and placebo soft laser treatment in patients with rotator cuff disease (stage II impingement syndrome). Design-Rand omised clinical trial. Setting-Hospital departments of orthopaedics an d of physical medicine and rehabilitation. Patients-125 patients aged 18-66 who had had rotator cuff disease for at least three months and w hose condition was resistant to treatment. Interventions-Arthroscopic subacromial decompression performed by two experienced surgeons; exerc ise regimen over three to six months supervised by one experienced phy siotherapist; or 12 sessions of detuned soft laser treatment over six weeks. Main outcome measures-Change in the overall Neer shoulder score (pain during previous week and blinded evaluation of function and ran ge of movement by one clinician) after six months. Results-No differen ces were found between the three groups in duration of sick leave and daily intake of analgesics. After six months the difference in improve ment in overall Neer score between surgery and supervised exercises wa s 4.0 (95% confidence interval -2 to 11) and 2.0 (-1.4 to 5.4) after a djustment for sex. The condition improved significantly compared with placebo in both groups given the active treatments. Treatment costs we re higher for those given surgery (720 Pounds v 390 Pounds). Conclusio ns-Surgery or a supervised exercise regimen significantly, and equally , improved rotator cuff disease compared with placebo.