Exercises found to be as effective as surgery for shoulder impingement – Four to eight year follow up study

Following on from a past QOH newsletter on the same condition a new article in the Scandinavian Journal of Rheumatology has done the first long-term follow up on surgery versus exercise for shoulder impingement: Article [1].

Haahr et al did a randomised trial comparing exercises with surgery for subacromial impingement. Patients had shoulder pain and positive signs for impingement. They were randomised to either arthroscopic subacromial decompression or conservative treatment with exercises.

There was very little loss to follow-up. There was no significant difference between the groups at up to four to eight years based on assessments of disability such as function, work capability, employment status and global improvement.

Previous studies have shown exercise to be effective compared to surgery [2].

It is worth noting that the majority of pain secondary to rotator cuff disease responds well to non-operative conservative intervention. The natural history of the disease is positive. It is worthwhile pursuing conservative treatment prior to surgical intervention.

The authors comment in their conclusion that when dealing with incomplete tears or impingement, the effects of surgery compared to conservative treatment are apparently not questioned. This study suggests that in the long run there may be no benefit from surgery for patients in these groups.

If you would like more information please contact David Allen.david allen@qoh.com.au

1. Haahr, J.P. and J.H. Andersen, Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4-8-years' follow-up in a prospective, randomized study. Scand J Rheumatol, 2006. 35(3): p. 224-8.
2. Haahr, J.P., et al., Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis, 2005. 64(5): p. 760-4.