Ds. Morrison et al., NONOPERATIVE TREATMENT OF SUBACROMIAL IMPINGEMENT SYNDROME, Journal of bone and joint surgery. American volume, 79A(5), 1997, pp. 732-737
We performed a retrospective study of 616 patients (636 shoulders) who
had subacromial impingement syndrome to assess the results of non-ope
rative treatment, The diagnosis was made on the basis of a positive im
pingement sign and the absence of other abnormalities of the shoulder,
such as full-thickness tears of the rotator cuff, osteoarthrosis of t
he acromioclavicular joint, instability of the glenohumeral joint, or
adhesive capsulitis. All patients were managed with anti-inflammatory
medication and a specific, supervised physical-therapy regimen consist
ing of isotonic exercises for strengthening of the rotator cuff, The a
verage duration of follow-up was twenty-seven months (range, six to ei
ghty-one months). Over-all, 413 patients (67 per cent) had a satisfact
ory result, One hundred and seventy-two patients (28 per cent) had no
improvement and went on to have an arthroscopic subacromial decompress
ion, Thirty-one patients (5 per cent) had an unsatisfactory result but
declined additional treatment, Seventy-four (IS per cent) of the 413
patients who had a successful result had a recurrence of the symptoms
during the follow-up period; the symptoms resolved with rest or after
resumption of the exercise program. The patients were stratified accor
ding to age, the duration of symptoms, and acromial morphology. Patien
ts who were twenty years old or less and those who were forty-one to s
ixty years old fared better than those who were twenty-one to forty ye
ars old, Patients who were more than sixty years old had the poorest r
esults. Sixty-seven (75 per cent) of the eighty-six patients in whom t
he symptoms had been present for less than four weeks had a satisfacto
ry result, compared with 144 (63 per cent) of the 228 who had had the
symptoms for one to six months and with 202 (67 per cent) of the 302 w
ho had had the symptoms for more than six months.