THE ROLE OF PHYSIOTHERAPY IN SUBACROMIAL IMPINGEMENT

Abstract

Aim: To assess the value of physiotherapy in the treatment of patients with subacromial impingement syndrome.

Methods: Patients with subacromial impingement syndrome were identified. Those who had not previously had any physiotherapy and had failed to respond to other types of non-surgical management were selected and placed on the waiting list for subacromial decompression. These patients were randomised into two groups. One group was referred for physiotherapy while waiting for surgery. The control group had no intervention prior to surgery. The patients in the physiotherapy group underwent an assessment and treatment by a single physiotherapist. All patients were evaluated independently after each of three and six months. The Constant Score was used to assess all patients initially and at each visit.

Results: Physiotherapy group: All patients (n=42) increased their Constant score. Eleven of the 42 patients (26%) improved to an extent that surgery was no longer required. In patients not requiring surgery, the mean improvement in the Constant score was 25 (range: 12 to 45) In the patients requiring surgery, (n=31), the mean improvement was 21 (range: three to 34). Patients not requiring surgery had a higher initial Constant score, 65 (range: 30–84) than those requiring surgery 48 (range: 17 to 59). Patients not requiring surgery also tended to be younger 52 (range: 27 to 68) than those requiring surgery 59 (range: 48 to 68).

Control Group: All patients (n=23) went on to have surgery. The mean improvement in Constant score was two (Range: −16 to 12).

Conclusions: All patients with subacromial impingement syndrome improved with physiotherapy when compared with a control group that did not receive physiotherapy. Some patients in the physiotherapy group (26%) improved to the extent that surgery was no longer required.