Issue №6-22, 2023

Case report

https://doi.org/10.38025/2078-1962-2023-22-6-117-123

Subacromial Impingement Syndrome. A Retrospective Analysis of Long-Term Outcomes of Surgical and Conservative Treatment

View article (Download PDF file)



Download XML file

1 ORCIDZhanna Yu. Pilipson ,1,2 ORCIDAndrey V. Korolev ,1,2 ORCIDDmitrii O. Ilyin ,1,2 ORCIDAleksey N. Logvinov ,1,2 ORCID, Alexander V. Frolov 1,2 ORCID,Dmitry A. Bessonov 3 ORCIDEvgeny E. Achkasov, 4Aleksander A. Olchev

1European Clinic of Sports Traumatology and Orthopedics (ECSTO)
2RUDN University
3First I.M. Sechenov Moscow State Medical University
4Ryazan City Clinical Emergency Hospital


ABSTRACT

INTRODUCTION. Subacromial impingement syndrome (SAIS) is one of the most common reasons that makes patients seek treatment for shoulder pain.

PURPOSE. To assess the effectiveness of surgical and conservative treatment of patients with subacromial impingement syndrome.

MATERIALS AND METHODS. The clinical results of 48 patients with SAIS stage 1, 2 according to Neer, divided into 3 groups, were analyzed: 1) conservative group without rotator cuff tears (16 patients), 2) conservative group with partial rotator cuff tears (16 patients); 3) surgical group (16 patients). The patients of the conservative groups were treated according to the rehabilitation protocol including myofascial release techniques, physiotherapy, manual therapy, exercises. The patients of the surgical group underwent an arthroscopic subacromial decompression. The follow-up period was at least 24 months. The clinical condition of the patients was assessed using ASES, VAS scales and SANE questionnaire.

RESULTS. The study did not reveal a statistically significant difference of the surgical and conservative treatment groups according to VAS and ASES. There was a statistically significant difference in the results of the SANE questionnaire (p = 0.008) with better results in the conservative groups. Longer rehabilitation was noted in patients of the surgical group.

DISCUSSION. Ketola et al. compared clinical results of surgical group of patients who underwent the subacromial decompression and the conservative group who performed the exercises. There was no statistically significant difference found in VAS level results, subjective shoulder function assessment. Paavola et al. have not found statistically significant difference in VAS scale results between surgical group, group of diagnostic arthroscopy and conservative group of patients with rotator cuff tendinopathy.

CONCLUSION. The conservative treatment of subacromial impingement syndrome with physiotherapy and manual therapy let achieve good and excellent results.


KEYWORDS: subacromial impingement syndrome, rotator cuff, scapula dyskinesis, subacromial decompression

Acknowledgments: The study had no sponsorship.

Conflict of interest:: The authors declare no apparent or potential conflicts of interest related to the publication of this article.

For citation: Pilipson Zh.Yu., Ilyin D.O., Logvinov A.N., Frolov A.V., Bessonov D.A., Achkasov E.E., Olchev A.A., Korolev A.V. Subacromial Impingement Syndrome. A Retrospective Analysis of Long-Term Outcomes of Surgical and Conservative Treatment. Bulletin of Rehabilitation Medicine. 2023; 22(6):117-123. https://doi.org/10.38025/2078-1962-2023-22-6-117-123 (In Russ.)

Для корреспонденции:  Zhanna Yu. Pilipson, E-mail: pilipsonshoulder@gmail.com, zhpilipson@emcmos.ru



Список литературы:

  1. Consigliere P., Haddo O., Levy O. et al. Subacromial impingement syndrome: management challenges. Orthopedic Research and Reviews. 2018; 10: 83–91. https://doi.org/10.2147/ORR.S157864
  2. Larsson R., Bernhardsson S., Nordeman L. et al. Effects of eccentric exercise in patients with subacromial impingement syndrome: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2019; 20: 446. https://doi.org/10.1186/s12891-019-2796-5
  3. Steuri R., Sattelmayer K., Elsig S. et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. British Journal of Sports Medicine. 2017 (18): 1340–1347. https://doi.org/10.1136/bjsports-2016-096515
  4. Neer Ch. Anterior Acromioplasty for the Chronic Impingement Syndrome in the Shoulder: A preliminary report. The Journal of Bone & Joint Surgery. 54(1): 41–50. 1972. https://doi.org/10.2106/jbjs.8706.cl
  5. Gebremariam L., Hay E. M., Van der Sande R. et al. Subacromial impingement syndrome — effectiveness of physiotherapy and manual therapy. British Journal of Sports Medicine. 2013; 48(16), 1202–1208. https://doi.org/10.1136/bjsports-2012-091802
  6. Umer. M., Qadir I., Mohsin Azam et al. Subacromial impingement syndrome Orthopedic Review (Pavia). 2012 May 9; 4(2): e18. https://doi.org/10.4081/or.2012.e18
  7. Yu E., Cil A., Harmsen W.S. et al. Arthroscopy and the dramatic increase in frequency of anterior acromioplasty from 1980 to 2005: an epidemiologic study. Arthroscopy 2010; 26(9 Suppl): S142–S147. https://doi.org/10.1016/j.arthro.2010.02.029
  8. Paavola M., Kanto K., Ranstam J. et al. For the Finnish Shoulder Impingement Arthroscopy Controlled Trial (FIMPACT) Investigators. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomized, placebo surgery controlled clinical trial. British Journal of Sports Medicine. 55(2): 99–107. https://doi.org/10.1136/bjsports-2020-102216
  9. Karjalainen T., Jain N., Page C. et al. Subacromial decompression surgery for rotator cuff disease. Cochrane Database Systematic Review. 2019(1): CD005619. https://doi.org/10.1002/14651858.CD005619.pub3
  10. Juul-Kristensen B., Marie Larsen C., Eshoj H. et al. Positive effects of neuromuscular shoulder exercises with or without EMG-biofeedback, on pain and function in participants with subacromial pain syndrome — a randomised controlled trial. Journal of Electromyography and Kinesiology. 2019. https://doi.org/10.1016/j.jelekin.2019.07.009
  11. Liaghat B., Pedersen J.R., Skov Husted R.S. et al. Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence — a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). British Journal of Sports Medicine. 2023; 57(7): 408–416. https://doi.org/10.1136/bjsports-2022-105674
  12. Hickey D., Solvig V., Cavalheri V. et al. Scapular dyskinesis increases the risk of future shoulder pain by 43 % in asymptomatic athletes: a systematic review and meta-analysis. British Journal of Sports Medicine. 2017; 52(2): 102–110. https://doi.org/10.1136/bjsports-2017-097559
  13. Nowotny J., Kasten P., Kopkow C. et al. Evaluation of a New Exercise Program in the Treatment of Scapular Dyskinesis. International Journal of Sports Medicine. 2018; 39(10): 782–790. https://doi.org/10.1055/a-0608-4584
  14. Moghadam N., Rahnama A., Dehkordi N. et al. Exercise therapy may affect scapular position and motion in individuals with scapular dyskinesis: a systematic review of clinical trials. Journal of Shoulder and Elbow Surgery. 2019. https://doi.org/10.1016/j.jse.2019.05.037
  15. Clausen M.B., Hölmich P., Rathleff M. et al. Effectiveness of Adding a Large Dose of Shoulder Strengthening to Current Nonoperative Care for Subacromial Impingement: A Pragmatic, Double-Blind Randomized Controlled Trial (SExSI Trial). American Journal of Sports Medicine. 2021; 49(11): 3040–3049. https://doi.org/10.1177/03635465211016008
  16. Ketola S., Lehtinen J., Arnala I. et al. Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy. The Bone & Joint Journal. 2017; 99-B(6): 799–805. https://doi.org/10.1302/0301-620x.99b6.bjj-2016-0569.r1
  17. Beard D.J., Rees J.L., Cook J.A. et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018; 391(10118): 329–338. https://doi.org/10.1016/s0140-6736(17)32457-1
  18. Roddy R., Ogollah R., Oppong R. et al. Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial. British Journal of Sports Medicine. 2021 55(5): 262–271. https://doi.org/10.1136/bjsports-2019-101268.
  19. Gunay Ucurum S., Kaya D.O, Kayali Y. et al. Comparison of different electrotherapy methods and exercise therapy in shoulder impingement syndrome: A prospective randomized controlled trial. .Acta Orthopaedica et Traumatologica Turcica. 2018; 52(4): 249–255. https://doi.org/10.1016/j.aott.2018.03.005.
  20. Schydlowsky P., Szkudlarek M., Madsen O.R. et al. Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial. BMC Musculoskeletal Disorders. 2022; 23: 52. https://doi.org/10.1186/s12891-021-04969-0



Creative Commons License
The content is available under the Creative Commons Attribution 4.0 License.

©

Эта статья открытого доступа по лицензии CC BY 4.0. Издательство: ФГБУ «НМИЦ РК» Минздрава России.
This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.