Primary studies included in this broad synthesis

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Primary study

Unclassified

Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: A two-year randomised controlled trial.

Journal The Journal of bone and joint surgery. British volume
Year 2009
Links Pubmed Health Technology Assessment (HTA) DOI crd.york.ac.uk

This article is included in 1 Systematic review Systematic reviews (1 reference)

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We report a randomised controlled trial to examine the effectiveness and cost-effectiveness of arthroscopic acromioplasty in the treatment of stage II shoulder impingement syndrome. A total of 140 patients were randomly divided into two treatment groups: supervised exercise programme (n = 70, exercise group) and arthroscopic acromioplasty followed by a similar exercise programme (n = 70, combined treatment group). The main outcome measure was self-reported pain on a visual analogue scale of 0 to 10 at 24 months, measured on the 134 patients (66 in the exercise group and 68 in the combined treatment group) for whom endpoint data were available. An intention-to-treat analysis disclosed an improvement in both groups but without statistically significant difference in outcome between the groups (p = 0.65). The combined treatment was considerably more costly. Arthroscopic acromioplasty provides no clinically important effects over a structured and supervised exercise programme alone in terms of subjective outcome or cost-effectiveness when measured at 24 months. Structured exercise treatment should be the basis for treatment of shoulder impingement syndrome, with operative treatment offered judiciously until its true merit is proven.

Primary study

Unclassified

Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: A prospective randomised study

Journal The Journal of bone and joint surgery. British volume
Year 2009
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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In a prospective randomised study we compared the results of arthroscopic subacromial bursectomy alone with debridement of the subacromial bursa followed by acromioplasty. A total of 57 patients with a mean age of 47 years (31 to 60) suffering from primary subacromial impingement without a rupture of the rotator cuff who had failed previous conservative treatment were entered into the trial. The type of acromion was classified according to Bigliani. Patients were assessed at follow-up using the Constant score, the simple shoulder test and visual analogue scores for pain and functional impairment. One patient was lost to follow-up. At a mean follow-up of 2.5 years (1 to 5) both bursectomy and acromioplasty gave good clinical results. No statistically significant differences were found between the two treatments. The type of acromion and severity of symptoms had a greater influence on the clinical outcome than the type of treatment. As a result, we believe that primary subacromial impingement syndrome is largely an intrinsic degenerative condition rather than an extrinsic mechanical disorder. © 2009 British Editorial Society of Bone and Joint Surgery.

Primary study

Unclassified

Radiofrequency-based plasma microtenotomy compared with arthroscopic subacromial decompression yields equivalent outcomes for rotator cuff tendinosis.

Journal Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
Year 2007
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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PURPOSE: This study aimed to determine whether radiofrequency (RF)-based plasma microtenotomy (microdebridement) was effective for treating chronic supraspinatus tendinosis. METHODS: The institutional ethics committee approved the study design, and all patients signed informed consent forms. Patients (age range, 30 to 70 years) were considered for enrollment if 6 months of active conservative treatment had failed and they had Neer stage II impingement syndrome, positive radiographic evidence of type II acromion, and magnetic resonance imaging or ultrasound evidence of supraspinatus tendinosis. Patients (N = 60) were randomly assigned to undergo arthroscopic subacromial decompression or RF-based plasma microtenotomy. For microtenotomy, a bipolar RF-based probe (TOPAZ; ArthroCare, Austin, TX) was used to perform microdebridement in the supraspinatus tendon; patients did not undergo acromioplasty. Outcomes evaluation consisted of self-reported pain via a visual analog scale, as well as functional assessment (American Shoulder and Elbow Surgeons [ASES] survey, Constant score, and University of California, Los Angeles [UCLA] questionnaire). Statistical analyses were performed by use of factorial dependent-measures analysis of variance tests. RESULTS: Age and baseline scores on the visual analog scale (mean +/- SD) were 52.0 +/- 6.7 and 53.2 +/- 6.6 years and 8.4 +/- 0.9 and 8.2 +/- 0.8 points in the microtenotomy and arthroscopic subacromial decompression groups, respectively. A significant reduction in pain (P < .001) and improved function (P < .001 for all measures) were observed in both groups postoperatively. Both treatment groups had almost identical longitudinal recovery profiles for pain relief (P = .416) and restoration of function (P = .964 for ASES score, P = .978 for Constant score, and P = .794 for UCLA score). At 1 year, the median pain score was 1.0, and all patients had ASES, Constant, and UCLA scores of greater than 90, greater than 80, and greater than 30, respectively. CONCLUSIONS: Both procedures were associated with significant improvement postoperatively, but the RF-based plasma microtenotomy procedure draws into question the need for a more extensive procedure such as subacromial decompression in this patient population. LEVEL OF EVIDENCE: Level I, therapeutic randomized controlled study.

Primary study

Unclassified

Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up.

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Journal Annals of the rheumatic diseases
Year 2005
Links Pubmed DOI PubMed Central

This article is included in 6 Systematic reviews Systematic reviews (6 references)

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OBJECTIVES: To compare the effect of graded physiotherapeutic training of the rotator cuff versus arthroscopic subacromial decompression in patients with subacromial impingement. METHODS: Randomised controlled trial with 12 months' follow up in a hospital setting. Ninety consecutive patients aged 18 to 55 years were enrolled. Symptom duration was between six months and three years. All fulfilled a set of diagnostic criteria for rotator cuff disease, including a positive impingement sign. Patients were randomised either to arthroscopic subacromial decompression, or to physiotherapy with exercises aiming at strengthening the stabilisers and decompressors of the shoulder. Outcome was shoulder function as measured by the Constant score and a pain and dysfunction score. &quot;Intention to treat&quot; analysis was used, with comparison of means and control of confounding variables by general equation estimation analysis. RESULTS: Of 90 patients enrolled, 84 completed follow up (41 in the surgery group, 43 in the training group). The mean Constant score at baseline was 34.8 in the training group and 33.7 in the surgery group. After 12 months the mean scores improved to 57.0 and 52.7, respectively, the difference being non-significant. No group differences in mean pain and dysfunction score improvement were found. CONCLUSIONS: Surgical treatment of rotator cuff syndrome with subacromial impingement was not superior to physiotherapy with training. Further studies are needed to qualify treatment choice decisions, and it is recommended that samples are stratified according to disability level.

Primary study

Unclassified

Open versus arthroscopic subacromial decompression: a prospective, randomized study of 34 patients followed for 8 years.

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Journal Acta orthopaedica Scandinavica
Year 2003
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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In a randomized prospective study, we selected 15 patients for arthroscopic subacromial decompression (ASD) and 19 patients for open subacromial decompression (OSD). All had impingement syndrome (Neer grade II), and had been unsuccessfully treated without surgery for more than 6 months. The UCLA Shoulder Rating Scale, Visual Analogue Scales for pain and satisfaction, isokinetic dynamometer recordings and physical testing were assessed preoperatively and at 1 (except isokinetic testing), 3, 6, and 12 months, and, finally, 8 years after surgery. We found essentially no differences in the clinical tests between the groups during this period. The use of ASD or OSD seems to be a matter of cosmesis and personal preference.

Primary study

Unclassified

Arthroscopic versus open acromioplasty: a prospective, randomized, blinded study.

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Journal Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
Year 2002
Links Pubmed DOI

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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The purpose of this study is to determine whether arthroscopic acromioplasty is equivalent or superior to open acromioplasty, in a prospective, randomized, controlled, blinded clinical trial. Seventy-one patients with a clinical diagnosis of impingement syndrome were randomized to arthroscopic or open acromioplasty. Nine were excluded because of full-thickness rotator cuff tears diagnosed after randomization. Sixty-two patients (49 men and 13 women) with a minimum follow-up of 12 months (mean, 25 months) were included. The patient groups were virtually identical with regard to duration of symptoms, shoulder functional demands, age, sex, hand dominance, mechanism of onset, range of motion, strength, joint laxity, and the presence of a compensation claim. Patients were prospectively randomized to arthroscopic or open acromioplasty after stratification for age (&gt;50 years),associated ligamentous laxity, and the presence of an ongoing compensation claim. The main outcome measure was visual analog scales for pain and function. Also recorded were UCLA shoulder scores and visual analog scales for postoperative improvement, patient satisfaction, and a variety of clinical measures. An independent blinded examiner assessed all patients. There was no significant difference between open and arthroscopic acromioplasty in visual analog scales for postoperative improvement (P =.30), patient satisfaction (P =.94), UCLA shoulder score (P =.69), or strength (P =.62); however, open was superior to arthroscopic acromioplasty for pain and function (P =.01). Overall, 67% of patients had a good or excellent result. This increased to 87% when unsettled compensation claims were excluded. Repeat (open) acromioplasty was performed in 5 patients in the unsuccessful arthroscopic group without improvement. Open acromioplasty was equivalent to arthroscopic acromioplasty for UCLA scores and patient satisfaction. For pain and function, both gave significant improvement but the open technique may be superior. Unsettled compensation is a predictor of poor outcome.

Primary study

Unclassified

Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up.

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Journal Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
Year 1999
Links Pubmed DOI

This article is included in 7 Systematic reviews Systematic reviews (7 references)

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The effectiveness of arthroscopic surgery, supervised exercises, and placebo was compared in 125 patients with rotator cuff disease (impingement syndrome stage II) in a randomized clinical trial. The median age was 48 years, and the median duration of complications was 1 to 2 years. The treatments were arthroscopic subacromial decompression performed by 2 experienced surgeons, an exercise regimen supervised for 3 to 6 months by 1 experienced physiotherapist, or 12 sessions of detuned soft laser (placebo) for 6 weeks. The criterion for success was a Neer shoulder score &gt; 80. Fifteen (50%) and 11 (22%) of the patients randomized to placebo and exercises, respectively, had surgery during the 2 1/2-year follow-up period and were classified as having failure with the treatments. The success rate was higher (P &lt; .01) for patients randomized to surgery (26 of 38) and exercises (27 of 44) compared with the placebo group (7 of 28). The odds ratio for success after surgery compared with exercises was 1.5 (95% confidence interval 0.6 to 3.7; P = .49). Including all patients who underwent operation, the success rate in those not on sick leave (19 of 21) before surgery was higher compared with those on sick leave (18 of 36) (adjusted odds ratio 5.6 [1.2 to 29.2]). Similar results were observed for patients not receiving versus those receiving regular pain medication before surgery (adjusted odds ratio 4.2 [1.2 to 15.8]).

Primary study

Unclassified

The subacromial impingement syndrome. A study of results of treatment with special emphasis on predictive factors and pain-generating mechanisms.

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Journal Scandinavian journal of rehabilitation medicine
Year 1999
Links Pubmed DOI

This article is included in 6 Systematic reviews Systematic reviews (6 references)

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Forty-two patients with subacromial impingement syndrome entered a randomized prospective study comparing open anterior acromioplasty with a physiotherapy regime. The criterion for a successful outcome of treatment was a reduction of the initial pain score of more than 50% using the visual analogue scale (VAS) technique. The evaluation was performed by an independent observer. At the 6-month follow-up, treatment in the surgical group had been successful in 12/21 (57%) patients versus 6/18 (33%) in the physiotherapy group. A one-year evaluation revealed 16/21 (76%) &quot;successes&quot; in the surgical group. A direct and unbiased comparison with the physiotherapy group was not possible at one year, since 13 patients chose surgery after initial physiotherapy. However, in &quot;an intention to treat&quot; analysis outcome at one year was significantly better in those randomized to surgery. We found two standardized, composite, active movements--the &quot;Pour out of a Pot&quot; manoeuvre requiring the emptying of a pot of water, and the &quot;Hand in Neck&quot; manoeuvre--to be of predictive value for the outcome of surgery. When combining three pain-related variables into a criterion for prediction of success, a sensitivity of 78% (p &lt; 0.02) and a specificity of 90% (p &lt; 0.03) were attained. We advance the hypothesis that pain in the impingement syndrome is mainly elicited by comparison of the subacromial bursa. In some patients a traction-responsive pain generator in the supraspinatus tendon may be present as well.

Primary study

Unclassified

Anterior acromioplasty. A comparison of two techniques.

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Journal International orthopaedics
Year 1997
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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A prospective randomised study was made of 20 patients who underwent acromioplasty for the chronic impingement syndrome. Ten were operated on by Neer's technique and 10 with a modification where the deltoid origin was spared. Rehabilitation was more rapid with a better range of movement in the latter group. Acromioplasty with this modification offers benefits compared with the standard procedure.

Primary study

Unclassified

Open versus arthroscopic subacromial decompression: analysis of one-year results.

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Journal Physiotherapy research international : the journal for researchers and clinicians in physical therapy
Year 1997
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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The results of open subacromial decompression (OSD) were compared with arthroscopic subacromial decompression (ASD) after 1 year in 32 subjects (4 bilateral), and the correlation between the two shoulder rating scales for impingement was documented. Patients were evaluated clinically on the modified University of California at Los Angeles (UCLA) shoulder rating scale, and Constant scale. Scapular position and rotation were evaluated as well as a rotation and abduction shoulder strength test using the Cybex II dynamometer. No parameters revealed significant differences between the groups, except for the UCLA score which indicated an advantage for the ASD group (p = 0.046). The OSD group scored 24.5 (5.45) on the UCLA scale and 73.8 (18.9) on the Constant scale, whereas the ASD group scored 28.3 (5.6) and 80.8 (16.4). To study the correlation between both scales, the Pearson correlation product-moment coefficient was calculated and a high correlation (r = 0.81) obtained. Less mobility was found in the operated arm for all parameters, with the exception of glenohumeral abduction in both groups and passive elevation in the OSD group. Only in the OSD group did the scapula in the operated extremity show more abduction of the inferior angle of the scapula. Weaker abduction strength in the operated side was found in the ASD group, whereas in the OSD group there was significantly less adduction and external rotation strength at 180 degrees/s en 240 degrees/s. We conclude that after one year the open group tends to catch up with the arthroscopic patients and that the main benefits after arthroscopic surgery as described in literature are more evident in the shorter period.