Subacromial Decompression Yields a Better Clinical Outcome Than Therapy Alone: A Prospective Randomized Study of Patients With a Minimum 10-Year Follow-up

Am J Sports Med. 2018 May;46(6):1397-1407. doi: 10.1177/0363546518755759. Epub 2018 Mar 15.


Background: The long-term outcome after the treatment of subacromial impingement syndrome (SAIS) with either nonsurgical or surgical methods has not been thoroughly investigated. Hypothesis/Purpose: The purpose was to evaluate the long-term clinical outcome and the presence of rotator cuff injuries and osteoarthritis (OA) after the surgical and nonsurgical treatment of SAIS. The hypothesis was that, at a minimum 10 years after the initial treatment, patients who had undergone acromioplasty would have a better clinical outcome and run a lower risk of developing rotator cuff ruptures and OA as compared with those treated with physical therapy.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: Eighty-seven patients with SAIS were randomized to 3 groups: open acromioplasty (open surgery group [OSG]), arthroscopic acromioplasty (arthroscopic surgery group [ASG]), and nonsurgical treatment (physical therapy group [PTG]). The Constant score, the Watson and Sonnabend score, and the 36-Item Short Form Health Survey (SF-36) questionnaire were used as outcome measurements. Furthermore, bilateral ultrasound examinations were performed to detect rotator cuff ruptures and bilateral radiographs to detect OA. Sixty-six patients (76%) attended the clinical follow-up at least 10 years after the initial treatment.

Results: The groups were demographically comparable at baseline. The Constant score improved significantly at follow-up for the OSG ( P = .003) and ASG ( P = .011), while no significant improvement was detected for the PTG. The OSG revealed a significant improvement versus the PTG at follow-up ( P = .011); otherwise, no significant differences were found. For the Watson and Sonnabend score, the OSG revealed a significant improvement in 13 of 14 questions. The corresponding finding was made for the ASG and PTG in 9 of 14 questions ( P = .14). According to ultrasound, 1 of 20 patients in the OSG had a full-thickness rotator cuff rupture on the index side. The corresponding finding was made for 1 of 18 patients in the ASG and 4 of 28 in the PTG ( P = .29). Per the radiographs, 3 of 20 patients in the OSG had moderate or severe OA in the index shoulder. The corresponding finding was made for 1 of 18 patients in the ASG and 0 of 28 in the PTG ( P = .12).

Conclusion: After a minimum 10 years of follow-up, the surgical treatment of SAIS appears to render better clinical results than physical therapy alone. No significant differences were found among the groups in terms of the presence of full-thickness rotator cuff ruptures and OA.

Keywords: long term; osteoarthritis; physical therapy; rotator cuff rupture; subacromial decompression; subacromial impingement.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Arthroplasty*
  • Arthroscopy*
  • Decompression, Surgical*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis / complications
  • Osteoarthritis / diagnostic imaging
  • Physical Therapy Modalities*
  • Prospective Studies
  • Risk Factors
  • Rotator Cuff Injuries / complications
  • Rotator Cuff Injuries / diagnostic imaging
  • Shoulder Impingement Syndrome / complications
  • Shoulder Impingement Syndrome / surgery*
  • Ultrasonography