Impingement syndrome: temporal outcomes of nonoperative treatment

J Shoulder Elbow Surg. Mar-Apr 2009;18(2):172-7. doi: 10.1016/j.jse.2008.09.005. Epub 2008 Dec 18.

Abstract

Hypothesis: We prospectively studied patients with impingement syndrome to look at outcomes of nonoperative treatment on a temporal basis.

Materials and methods: Temporal outcomes of 100 consecutive patients treated for impingement syndrome were prospectively evaluated. All patients began a standardized, nonoperative treatment protocol consisting of a subacromial steroid injection, followed by physical therapy.

Results: Data were available on 94 patients at the final two-year follow-up assessment. Overall, 74 of 94 patients did not require surgery. In that group, the average American Shoulder and Elbow Surgeons (ASES) outcome score increased from 56 to 95, with an average decrease in the pain score from 4.8 to 0.6. Improvement was demonstrated in patient shoulder outcome scores (ASES score) and visual analog pain scores between treatment initiation and the one-year follow-up assessment (p < .0001); no improvement was identified past one year. Of the non-surgical patients, 22 continued to have some shoulder pain.

Conclusion: Of patients with impingement syndrome treated nonoperatively, 79% did not require surgery after two-year follow-up. Predictors of patients going on to surgical intervention included the total number of subacromial steroid/lidocaine injections and patient response to the initial subacromial injection. Of the patients not undergoing surgery, 30% continued to have some shoulder pain.

Level of evidence: Level 1; Prospective prognosis study, >80% follow-up.

MeSH terms

  • Adult
  • Aged
  • Humans
  • Injections, Intralesional
  • Middle Aged
  • Pain Measurement
  • Physical Therapy Modalities
  • Prospective Studies
  • Shoulder Impingement Syndrome / therapy*
  • Steroids / administration & dosage
  • Treatment Outcome

Substances

  • Steroids