Exercise As Effective as Surgery for Shoulder Injury

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Exercise As Effective as Surgery for Shoulder Injury

Shoulder injuries are common and often referred for treatment through surgical means. Researchers from Denmark compared the outcome of arthroscopic subacromial decompression surgery and exercise training in patients suffering from shoulder pain, defined as meeting a fulfilled set of diagnostic criteria for rotator cuff disease, including a positive impingement sign.

Eighty-four participants were randomized into a surgical intervention group (41 patients) or physiotherapeutic exercise group (43 patients). Patients were evaluated at baseline before intervention and filled out a questionnaire regarding pain and impairment levels. Treatment in the surgery group "consisted of bursectomy with partial resection of the antero-inferior part of the acromion and the coracoacromail ligament." The exercise group received 19, 60-minute sessions consisting of the application of heat, cold packs, or soft-tissue treatments, followed by periscapular muscle training and rotator cuff strengthening exercise sessions.
Results: Both groups were evaluated at three, six and 12 months using the Constant score, "which is a joint measure of four subscores: pain measured on a visual analogue scale (VAS); limitations in activities of daily living; active range of motion in four directions in the shoulder joint; and isometric shoulder strength measured in kg with a portable muscle strength analyzer." A Constant score totaling 100 indicated normal function. After one year, patients filled out a follow-up questionnaire repeating the questions asked at baseline. At baseline, the exercise training group Constant score was 34.8, while the surgery group was 33.7. After intervention, the exercise training group Constant score improved to 54.8, 55.5, and 57.0 after three, six and 12 months, respectively, while the surgery group's scores were 49.2, 53.8 and 52.7. After one year, 20 participants (10 in each group) reported a score of 80 or higher. The mean score in the exercise group indicating overall improvement was 23, while the surgery group scored 18.8. Two patients in the exercise group and eight patients in the surgery group had reductions in the Constant score.
The researchers note study limitations, including "a weakness that the baseline Constant scoring was not done before randomization and was postponed until just before the start of the treatments. The self reported pain and dysfunction score may also be biased by the patients' own preferences for a particular treatment, which have not been recorded." Study limitations notwithstanding, the researchers concluded they "are now more reluctant to recommend surgery in cases with stage II impingement."
Haahr JP, Ostergaard S, Dalsgaard J, 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;64:760-764.