ROLE OF CONSERVATIVE TREATMENT IN SHOULDER SUBACROMIAL IMPINGEMENT SYNDROME
Main Article Content
Keywords
Shoulder subacromial impingement syndrome, Conservative treatment, Physical therapy, Non-steroidal anti-inflammatory drugs (NSAIDs), Corticosteroid injections, Activity modification
Abstract
Shoulder subacromial impingement syndrome (SAIS) is a common cause of shoulder pain and dysfunction, characterized by compression of the structures within the subacromial space during arm elevation. While surgical interventions such as subacromial decompression have traditionally been considered the primary treatment approach, conservative management plays a critical role in the comprehensive management of SAIS. This abstract explores the role of conservative treatment modalities, including physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and activity modification, in the management of SAIS. Conservative treatment aims to alleviate pain, restore shoulder function, and address underlying biomechanical factors contributing to impingement. Physical therapy interventions focus on strengthening the rotator cuff and scapular stabilizers, improving shoulder range of motion, and optimizing shoulder biomechanics. NSAIDs and corticosteroid injections are used to reduce inflammation and pain, particularly in the acute phase of impingement. Additionally, activity modification strategies aim to minimize aggravating activities and promote shoulder rehabilitation. Overall, conservative treatment serves as a valuable first-line approach in the management of SAIS, offering effective symptom relief and functional improvement while minimizing the need for surgical intervention.
References
2. Blair, B., Rokito, A. S., Cuomo, F., Jarolem, K., & Zuckerman, J. D. (1996). Efficacy of injections of corticosteroids for subacromial impingement syndrome. JBJS, 78(11), 1685-9.
3. Hanratty, C. E., McVeigh, J. G., Kerr, D. P., Basford, J. R., Finch, M. B., Pendleton, A., ... & Sim, J. (2012). The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 42(3), 297-316.
4. Hegedus, E. J., Goode, A. P., Cook, C. E., Michener, L., Myer, C. A., & Myer, D. M. (2012). Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. British Journal of Sports Medicine, 46(14), 964-978.
5. Lenza, M., Buchbinder, R., Takwoingi, Y., Johnston, R. V., Hanchard, N. C., & Faloppa, F. (2013). Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database of Systematic Reviews, (9).
6. Min, K. S., Pierre, P. S., Ryan, P. M., Marchant, B. G., Wilson, C. J., & Arrington, E. D. (2013). A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome. Journal of Shoulder and Elbow Surgery, 22(5), 595-601.
7. Kuhn, J. E. (2009). Exercise in the treatment of rotator cuff impingement: A systematic review and a synthesized evidence-based rehabilitation protocol. Journal of Shoulder and Elbow Surgery, 18(1), 138-160.
8. Moosmayer, S., & Smith, H. J. (2005). Diagnostic ultrasound of the shoulder—a method for experts only? Results from an orthopedic surgeon with relative inexperience compared to operative findings. Acta orthopaedica, 76(4), 503-508.
9. Consigliere, P., Haddo, O., Levy, O., & Sforza, G. (2018). Subacromial impingement syndrome: management challenges. Orthopedic research and reviews, 83-91.
10. Dickens, V. A., Williams, J. L., & Bhamra, M. S. (2005). Role of physiotherapy in the treatment of subacromial impingement syndrome: a prospective study. Physiotherapy, 91(3), 159-164.
11. Garving, C., Jakob, S., Bauer, I., Nadjar, R., & Brunner, U. H. (2017). Impingement syndrome of the shoulder. Deutsches Ärzteblatt International, 114(45), 765.
12. Senbursa, G., Baltacı, G., & Atay, A. (2007). Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. Knee surgery, sports traumatology, arthroscopy, 15, 915-921.
13. Clausen, M. B., Merrild, M. B., Witten, A., Christensen, K. B., Zebis, M. K., Hölmich, P., & Thorborg, K. (2018). Conservative treatment for patients with subacromial impingement: Changes in clinical core outcomes and their relation to specific rehabilitation parameters. PeerJ, 6, e4400.
14. Nazari, G., MacDermid, J. C., Bryant, D., & Athwal, G. S. (2019). The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome. A systematic review and meta-analysis. PLoS One, 14(5), e0216961.
15. Nyberg, A., Jonsson, P., & Sundelin, G. (2010). Limited scientific evidence supports the use of conservative treatment interventions for pain and function in patients with subacromial impingement syndrome: randomized control trials. Physical Therapy Reviews, 15(6), 436-452.
16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71
17. Habermeyer P: Schulterchirurgie, 4th ed., 2010 . Reproduced with the kind permission of Elsevier GmbH, Urban & Fischer, Munich, Germany
18. Saltychev, M., Äärimaa, V., Virolainen, P., & Laimi, K. (2015). Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disability and rehabilitation, 37(1), 1-8.
19. Steuri, R., Sattelmayer, M., Elsig, S., Kolly, C., Tal, A., Taeymans, J., & Hilfiker, R. (2017). Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. British journal of sports medicine, 51(18), 1340-1347.
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Dr. Waleed K. Abduh
KFH, Medina, Saudi Arabia
Dr. Mohammed E. Daghistani
KFH, medina, Saudi Arabia
Dr. Meshal Y. Koshok
MGH, medina, Saudi Arabia
Dr. Hani A. Halwany
KFH, medina, Saudi Arabia