NONOPERATIVE TREATMENT OF SUBACROMIAL IMPINGEMENT SYNDROME

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.