Article Review: Swedish clinical trial reduces shoulder surgeries

A Swedish study from Linköping University focusing on subacromial impingement syndrome has found a specific exercise program that helped 80% of compliant patients seeking arthroscopic subacromial decompression avoid surgery. The study compared a group given exercises targeting strength of the rotator cuff and scapula stabilizers to a group given non-specific neck and shoulder movement exercises. Measures included Constant-Murley shoulder assessment score, Hospital Anxiety and Disability (HAD) score, Disabilities of arm, shoulder and hand score, Health related quality of life measured with EQ-5D (European Quality of Life-5 Dimension score) and Visual analogue scale.

102 patients took part in the study, and 97 were considered at final analysis. All the patients were on a waitlist for arthroscopic subacromial decompression at the Department of Orthopedics at Linköping University Hospital. At baseline, both groups were very similar in terms of age, type of occupation (light or heavy shoulder load), number of rotator cuff tears and HAD score. The specific exercise group did exercises as shown in the video above. All the patients had tried conservative treatments, including exercise therapy for many patients, but they were not helped sufficiently. Interestingly, a unique pain monitoring model was used with both groups. The pain monitoring model  allowed pain to go up to a 5 on a 0 to 10 scale during exercise (with 0 as no pain, and 10 as the worst pain imaginable), but if the pain continued to the next morning, or became greater over time, the intensity of exercise was reduced.  Another interesting aspect of this study is a focus on eccentric exercises for the rotator cuff, and eccentric/concentric exercises for scapular stabilizers. As noted by the authors, in rehabilitation of other types of tendon injuries, especially the Achilles tendon, eccentric exercises have been shown to be especially effective.

There was a 15-point difference between the specific exercise group and the control exercise group in Constant-Murley score. The specific exercise group had a mean 24-point improvement in score. In the disabilities of the arm shoulder and hand score, the specific exercise group had an 8-point higher mean score. Health related quality of life measured by EQ-5D was significantly higher for the specific exercise group. Importantly, 69% of specific group patients rated their treatment as successful, compared to 24% of the unspecific exercise group. Only 20% of the specific exercise group still underwent surgery, while 63% of the control group did. Using the exercises outlined in this study appears to help subacromial impingement sufferers recover without surgery.


Holmgren T, Björnsson Hallgren H, Öberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ. 2012 Feb 20;344:e787. doi: 10.1136/bmj.e787. PubMed PMID: 22349588; PubMed Central PMCID: PMC3282676. Full free text from BMJ Open Access available here.

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