Exercise therapy for treatment of shoulder impingement syndrome?

Subacromial impingement syndrome is the most common indication for shoulder operation. However, exercise therapy for the conservative treatment is suggested  in the first instance. The aim of the study was to evaluate the implementation of exercise therapy in impingement syndrome.   A total of 104 consecutive patients who had undergone shoulder surgery due to impingement syndrome. Patients were questioned about therapy modalities that they had received before and after the operation as well as pain (VAS) and functional impairment (ASES) at one-year follow-up.  Before surgery 49% of patients had not received advice for shoulder muscle exercises. Following operation all patients had received mobility exercises, but one quarter of patients still reported that they had not received instructions about shoulder strength exercises. At the follow-up the means of the ASES index was 85 and use of NSAID had gone down by 75%. However, 15% of patients had moderate functional impairment (ASES under 60).  About half of patients reported that they had not received advice for rotator cuff exercise therapy before surgery even though with it surgery would very likely have been avoided in many cases. Although symptoms in most patients had decreased after operation, several patients still suffered from pain and decreased function. Still several patients had not received advice for shoulder strengthening exercises that are important to recovery.

The researchers found that the adherence to the current recommendations about exercise therapy is insufficient in clinical practice and recommended that it should be monitored in all institutions in which shoulder pain is treated.