Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review

Arch Phys Med Rehabil. 2011 Nov;92(11):1900-13. doi: 10.1016/j.apmr.2011.06.006.


Objective: To provide an evidence-based overview of the effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome.

Data sources: The Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched.

Study selection: Two reviewers independently selected relevant systematic reviews and randomized controlled trials (RCTs).

Data extraction: Two reviewers independently extracted data and assessed the methodologic quality.

Data synthesis: If pooling of data was not possible, a best-evidence synthesis was used to summarize the results.

Results: One review and 5 RCTs reporting on various surgical techniques, and postsurgical interventions were included. Moderate evidence was found in favor of adding platelet-leukocyte gel versus open subacromial decompression. No evidence was found for the superiority of subacromial decompression versus conservative treatment in the short, mid, and long term or in favor of 1 surgical technique when compared with another. Limited evidence was found in favor of early activation after arthroscopic decompression in the short and long term.

Conclusions: This review shows that there is no evidence that surgical treatment is superior to conservative treatment or that 1 particular surgical technique is superior to another. Because of possibly lower risks for complications, conservative treatment may be preferred. When choosing for surgery, arthroscopic decompression may be preferred because of the less invasive character of the procedure.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal
  • Arthroscopy
  • Decompression, Surgical
  • Humans
  • Physical Therapy Modalities
  • Randomized Controlled Trials as Topic
  • Shoulder Impingement Syndrome / rehabilitation*
  • Shoulder Impingement Syndrome / surgery*
  • Treatment Outcome


  • Anti-Inflammatory Agents, Non-Steroidal