Conservative interventions in shoulder impingement
For the management of shoulder impingement syndrome (SIS), exercise was found to be superior to control interventions; specific exercise showed greater effectiveness than generic exercise.
Ultrasound-guided corticosteroid injections, NSAIDs and manual therapy were superior to non-guided injections and placebo, respectively. Manual therapy was superior to exercise in short follow-up periods.
ECSWT, laser and tape were superior to sham treatment. It remains unclear how these treatments compare to exercise.
Shoulder-related complaints are among the most frequent in primary care. Of these, SIS is the most prevalent and can have a significant impact on quality of life. Despite this, a comprehensive review of all interventions and an analysis of outcomes related to multiple levels of disability are still missing.
200 RCTs were selected for analysis. Risk of bias was assessed using the Cochrane Colaboration’s tool. Quality of evidence was assessed through the GRADE tool. Outcome measures selected were pain, overall function and AROM.
Very low quality evidence showed that specific exercise, ultrasound-guided injections, NSAIDs, manual therapy, ECSWT, laser and tape produced positive effects of varying magnitudes.
This review added to the existing literature by providing data related to multiple outcome measures and highlighted the need for better quality of research on SIS management.
Nevertheless, authors suggest exercise as the core intervention for SIS with manual therapy, laser and tape as adjuncts.
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> From: Steuri et al., Br J Sports Med 51 (2017) 1340-1347(Epub ahead of print). All rights reserved to BMJ Publishing Group Ltd. Click here for the online summary.