IS PHYSIOTHERAPY BENIFICAL AFTER ARTHROSCOPIC SUBACROMIAL DECOMPRESSION?

Abstract

Purpose: to determine the effect of physiotherapy following arthroscopic subacromial decompression (ASD) for impingement syndrome

Methods: 50 patient undergoing ASD with or without excision of the distal clavicle (EDC) were randomized to have physiotherapy (physio group), or mobilize as tolerated and self exercise (no physio group). Patients in the physio group had an average of 7.4 sessions of physiotherapy under the guidance of a physiotherapist. Exercises included scapula stabilizer, passive, active-assisted, active and strengthening exercises developed at the Nuffield Orthopaedic Centre in Oxford. Patients in the no physio group were encouraged to mobilize their shoulders as tolerated and were given a leaflet with shoulder exercises. Patients were followed-up by postal Oxford shoulder questionnaires at 6 weeks, 3 months 6 months and 1 year. Time to return to work was used as secondary outcome measure.

Results: Our data showed that there was a significant difference between the average Oxford shoulder scores of the two groups at 6 weeks with the no physio group doing better (physio group: 34.3 vs. no physio group: 27.4, p=0.01) No difference was found between the two groups at 3 months, 6 months and 1 year in any of the outcome measures.

Conclusion: Patients not having formal physiotherapy seemed to have done better in the first 6 weeks after surgery with physio patients catching up later resulting in no difference in the final outcome between the groups. New therapy protocols should be developed to see if outcomes can be improved, but physiotherapy may not be necessary after ASD at all.