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Randomized Controlled Trial
. 2007 Feb 22;8:15.
doi: 10.1186/1471-2474-8-15.

A New Interdisciplinary Treatment Strategy Versus Usual Medical Care for the Treatment of Subacromial Impingement Syndrome: A Randomized Controlled Trial

Free PMC article
Randomized Controlled Trial

A New Interdisciplinary Treatment Strategy Versus Usual Medical Care for the Treatment of Subacromial Impingement Syndrome: A Randomized Controlled Trial

Oscar Dorrestijn et al. BMC Musculoskelet Disord. .
Free PMC article


Background: Subacromial impingement syndrome (SIS) is the most frequently recorded shoulder disorder. When conservative treatment of SIS fails, a subacromial decompression is warranted. However, the best moment of referral for surgery is not well defined. Both early and late referrals have disadvantages - unnecessary operations and smaller improvements in shoulder function, respectively. This paper describes the design of a new interdisciplinary treatment strategy for SIS (TRANSIT), which comprises rules to treat SIS in primary care and a well-defined moment of referral for surgery.

Methods/design: The effectiveness of an arthroscopic subacromial decompression versus usual medical care will be evaluated in a randomized controlled trial (RCT). Patients are eligible for inclusion when experiencing a recurrence of SIS within one year after a first episode of SIS which was successfully treated with a subacromial corticosteroid injection. After inclusion they will receive injection treatment again by their general practitioner. When, after this treatment, there is a second recurrence within a year post-injection, the participants will be randomized to either an arthroscopic subacromial decompression (intervention group) or continuation of usual medical care (control group). The latter will be performed by a general practitioner according to the Dutch National Guidelines for Shoulder Problems. At inclusion, at randomization and three, six and 12 months post-randomization an outcome assessment will take place. The primary outcome measure is the patient-reported Shoulder Disability Questionnaire. The secondary outcome measures include both disease-specific and generic measures, and an economic evaluation. Treatment effects will be compared for all measurement points by using a GLM repeated measures analyses.

Discussion: The rationale and design of an RCT comparing arthroscopic subacromial decompression with usual medical care for subacromial impingement syndrome are presented. The results of this study will improve insight into the best moment of referral for surgery for SIS.


Figure 1
Figure 1
Study design and follow-up procedures. Follow-up procedures. At T0, potential participants are contacted by phone. After informed consent is received, patients are included. At T0, T2 and T3 questionnaires will be returned by mail. At T1 and T4 participants visit the hospital (H.V.).

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    1. Bot SD, van der Waal JM, Terwee CB, van der Windt DA, Schellevis FG, Bouter LM, Dekker J. Incidence and prevalence of complaints of the neck and upper extremity in general practice. Ann Rheum Dis. 2005;64:118–123. doi: 10.1136/ard.2003.019349. - DOI - PMC - PubMed
    1. van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995;54:959–964. - PMC - PubMed
    1. Winters JC, Jongh de AC, Windt van der DAWM, Jonquière M, Winter de AF, Heijden van der GJMG, Sobel JS, Goudswaard AN. Schouderklachten. NHG Standaard M08 (National Guidelines for Shoulder Complaints of the Dutch College for General Practitioners). Huisarts Wet. 1999;42:222–231.
    1. Neer CS. Impingement lesions. Clin Orthop Relat Res. 1983:70–77. - PubMed
    1. Altchek DW, Warren RF, Wickiewicz TL, Skyhar MJ, Ortiz G, Schwartz E. Arthroscopic acromioplasty. Technique and results. J Bone Joint Surg Am. 1990;72:1198–1207. - PubMed

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