Introduction. Health Economists in Denmark have recently reported low and delayed return to work for patients treated for Sub-Acromial Impingement syndrome (SAIS) by Arthroscopic Sub-Acromial Decompression (ASAD). Surgeons however are reporting that patients achieve good pain relief and a high standard of activities of daily living (ADL) after surgery. Aim. To evaluate the effectiveness of ASAD for patients with SAIS and correlate clinical outcome with rate of return to work. Methods. Prospective cohort study and retrospective review of data from the Nottingham Shoulder database (presentation: 01/04/2008–30/06/2011). Inclusion criteria: Patients diagnosed clinically with SAIS by an experienced shoulder surgeon, who have failed conservative treatment (physiotherapy and sub-acromial injection), undergoing ASAD. Pre-operative and 6-month follow-up Oxford Shoulder Score (OSS) and Constant Score (CS) were compared. The rates of return to pre-operative level of work were also analysed. Statistical analysis: Wilcoxon signed rank test. Results. 73 patients with OSS (51 also with CS documentation) were included. The improvement in median OSS between pre-operative (24) and 6-month follow-up (39) was +15 (Z = −6.726, ∗∗∗, T=6, r=0.55). The difference in median CS between pre-operative (39) and 6-month follow-up (67) was +28 (Z=−5.435, T=6, r=0.59, ∗∗∗). Improvement in median pain score was +5 (7,12, ∗∗∗) median ADL was +5.5 (10.5,16, ∗∗∗) median ROM was +13 (18,31, ∗∗∗) and median strength was +4 (3,7, ∗∗∗). 76% returned to their pre-operative level of work (mean time = 11.5 weeks post surgery). 79% returned to their pre-operative hobbies (mean time = 11.8 weeks post surgery). Conclusion. There is a significant improvement in OSS and CS, 6 months after ASAD in patients with SAIS who have had previous failed conservative treatment. The rate of return to work was good for these patients in contrast to that reported for Danish patients. (∗∗∗ = p< 0.0001 = Highly statistically significant)

Introduction. Subacromial corticosteroid injection is widely used in the treatment of Subacromial Impingement Syndrome (SIS). There is increasing interest in using ultrasound (US) to improve the accurate placement of injections. This study investigated whether the accuracy of placement of US-guided subacromial corticosteroid injections influences patients' outcome of pain and function. Method. Secondary analysis of data from a 2−2 factorial randomised controlled trial investigating exercise and corticosteroid injection for pain and function in SIS. US-guided injections were delivered according to a pre-defined protocol. Video images were reviewed to categorise accuracy of injection into the subacromial bursa into 3 accuracy groups using pre-defined criteria: 1) not in the subacromial bursa; 2) probably in the subacromial bursa; and 3) definitely in the subacromial bursa. The primary outcome measure was the self-reported Shoulder Pain and Disability Index (SPADI) total score, compared at 6 weeks and 6 months. Secondary outcomes included SPADI pain and function subscales and participant global rating of overall change from baseline. A mixed effects model was used to compare accuracy groups' outcomes at 6 weeks and 6 months, adjusted for baseline covariates. Results. US-guided injection accuracy data were available for 114 participants; with 22 participants in group 1, 21 in group 2 and 71 in group 3. There were no significant differences in mean SPADI scores among the three injection accuracy groups at 6 weeks (group 2 vs. 1: 8.22 (95% CI −4.01, 20.50); group 3 vs. 1: −0.57 (−10.27, 9.13)) and 6 months (group 2 vs. 1: 12.38 (−5.34, 30.10); group 3 vs. 1: 3.10 (−11.04, 17.23)). Similarly, no differences between accuracy groups were seen in SPADI pain, SPADI function or participant global rating of change. Conclusion. The accuracy of US-guided subacromial corticosteroid injection in SIS does not influence clinical response to the injection, questioning the need for guided injections. Larger, adequately powered studies are required to explore this further

The purpose of this study was to compare the outcomes of arthroscopic unilateral surgery and simultaneous bilateral surgery for posterior ankle impingement syndrome (PAIS) in athletes and to evaluate the usefulness of simultaneous bilateral surgery.

A total 48 hindfeet of 41 athletes (14 hindfeet of 14 males, 34 hindfeet of 27 females) who underwent arthroscopic surgery for PAIS were studied. Japanese society for surgery of the foot (JSSF) score and visual analogue scale (VAS) were compared before and after surgery, using Wilcoxon signed-rank test. The operation time and the time to return to sports activity were compared in 10 hindfeet of 5 patients who underwent simultaneous bilateral surgery and 38 hindfeet of 36 patients who underwent unilateral surgery, using Wilcoxon rank sum test.

Classic ballet was the most common type of sport that caused PAIS (59%, 24/41 athletes). Soccer (10%, 4/41 athletes), baseball (10%, 4/41 athletes), badminton (5%, 2/41 athletes), volleyball (5%, 2/41 athletes), and athletics (5%, 2/41 athletes) followed. The JSSF score improved significantly from 72.7 preoperatively to 98.9 postoperatively in unilateral surgery, and significantly improved from 75.2 preoperatively to 99.0 postoperatively in simultaneous bilateral surgery. VAS significantly decreased from 64.7 preoperatively to 4.8 postoperatively in unilateral surgery, and significantly decreased from 72.7 preoperatively to 1.0 postoperatively in simultaneous bilateral surgery. The operating time was 53.7 minutes on average for unilateral surgery and 101.0 minutes for simultaneous bilateral surgery, significantly longer in bilateral simultaneous surgery. The mean time to return to sports activity was 4.8 weeks for unilateral surgery and 9.6 weeks for simultaneous bilateral surgery, significantly longer in simultaneous bilateral surgery.

Both unilateral and simultaneous bilateral surgeries for PAIS in athletes were useful. It should be noted that the operating time and the time to return to sports will be longer. However, considering the 2 times hospitalizations and 2 times surgeries, simultaneous bilateral surgery is one of the treatment options for PAIS.

Interstitial supraspinatus tears can cause persistent subacromial impingement symptoms despite non operative treatment. Autologous tendon cell injection (ATI) is a non-surgical treatment for tendinopathies and tear. We report a randomised controlled study of ATI compared to corticosteroid injection (CS) as treatment for interstitial supraspinatus tears and tendinopathy.

Inclusion criteria were patients with symptom duration > 6 months, MRI confirmed intrasubstance supraspinatus tear, and prior treatment with physiotherapy and ≥ one CS or PRP injection. Participants were randomised to receive ATI to the interstitial tear or corticosteroid injection to the subacromial bursa in a 2:1 ratio, under ultrasound guidance. Assessments of pain (VAS) and function (ASES) were performed at baseline, and 1, 3, 6 and 12 months post treatment.

30 participants (19 randomised to ATI) with a mean age of 50.5 years (10 females) and a mean duration of symptoms of 23.5 months. Baseline VAS pain and ASES scores were comparable between groups. While mean VAS pain scores improved in both groups at 3 months after treatment, pain scores were superior with ATI at 6 months (p=0.01). Mean ASES scores in the ATI group were superior to the CS group at 3 months (p=0.026) and 6 months (p=0.012). Seven participants in the CS group withdrew prior to 12 months due to lack of improvement. At 12 months, mean VAS pain in the ATI group was 1.6 ± 1.3. The improvements in mean ASES scores in the ATI group at 6 and 12 months were greater than the MCID (12.0 points). At 12 months, 95% of ATI participants had an ASES score > the PASS (patient acceptable symptom state).

This is the first level one study using ATI to treat interstitial supraspinatus tear. ATI results in a significant reduction in pain and improvement in shoulder function.

The primary treatment goal for patients with femoroacetabular impingement syndrome, a common hip condition in athletes, is to improve pain and function. In selected patients, in the short term following intervention, arthroscopic hip surgery is superior to a pragmatic NHS- type physiotherapy programme. Here, we report the three-year follow-up results from the FemoroAcetabular Impingement Trial (FAIT), comparing arthroscopic hip surgery with physiotherapy in the management of patients with femoroacetabular impingement (FAI) syndrome.

Two-group parallel, assessor-blinded, pragmatic randomised controlled study across seven NHS England sites. 222 participants aged 18 to 60 years with FAI syndrome confirmed clinically and radiologically were randomised (1:1) to receive arthroscopic hip surgery (n = 112) or physiotherapy and activity modification (n = 110). We previously reported on the hip outcome score at eight months. The primary outcome measure of this study was minimum Joint Space Width (mJSW) on Anteroposterior Radiograph at 38 months post randomisation. Secondary outcome measures included the Hip Outcome Score and Scoring Hip Osteoarthritis with MRI (SHOMRI) score.

Minimum Joint Space Width data were available for 101 participants (45%) at 38 months post randomisation. Hip outcome score and MRI data were available for 77% and 62% of participants respectively. mJSW was higher in the arthroscopy group (mean (SD) 3.34mm (1.01)) compared to the physiotherapy group (2.99mm (1.33)) at 38 months, p=0.017, however this did not exceed the minimally clinically important difference of 0.48mm. SHOMRI score was significantly lower in the arthroscopy group (mean (SD) 9.22 (11.43)) compared to the physiotherapy group (22.76 (15.26)), p-value <0.001. Hip outcome score was higher in the arthroscopy group (mean (SD) 84.2 (17.4)) compared with the physiotherapy group (74.2 (21.9)), p-value < 0.001).

Patients with FAI syndrome treated surgically may experience slowing of osteoarthritisprogression and superior pain and function compared with patients treated non- operatively.

Background

Shoulder impingement syndrome (SIS) is a common debilitating condition, treated across multiple health disciplines including Orthopaedics, Physiotherapy, and Rheumatology. There is little consistency in diagnostic criteria with ‘Shoulder impingement syndrome’ being used for a broad spectrum of complex pathologies. We assessed patterns in diagnostic procedures for SIS across multiple disciplines.

We examined 524 patients with whiplash injuries for delayed onset of shoulder pain in order to establish whether this was due to impingement syndrome. A total of 476 patients (91%) responded to a questionnaire of which 102 (22%) were entered into the study; 43 had both a positive impingement sign and Neer test. The incidence of impingement-type pain was 9%. After treatment 23 patients (5%) had a significant improvement in their symptoms, ten (2%) had a moderate improvement and nine had no improvement. Impingement-type pain can occur after whiplash injuries and can be successfully treated.

Introduction: The anterior femoroacetabular impingement syndrome has so far been a great unknown in orthopedic surgery. It is typically characterized by pain when the hip is subjected to the flexion – adduction – internal rotation movement. This pain is provoked by the impaction of the head-neck interface on the anterior wall of the acetabulum. The reason for this may be a retroverted acetabulum, an excessively prominent anterosuperior femoral head-neck junction or a combination of both. For many years, patients have been diagnosed with “adductor tendinopathy” or “inguinal herniations”, when in fact they had a coxofemoral problem.

Materials and methods: The first 14 cases operated were analyzed; all of them were young patients who played sports regularly. Using the modified Smith-Petersen approach, an osteoplasty was made in order to resect in the anterior wall and the superior walls of the acetabulum – the latter only in part – and the prominent head-neck junction of the femur. The result was an improvement in the joint balance and the disappearance of impingement. Unlike other authors (Ganz, Trousdale), we avoided an osteotomy of the greater trochanter as a surgical approach.

Results: In 13 of the first 14 cases operated with the technique described, immediate pain relief was achieved on internal flexorotation. ROM went from −17 ° mean internal rotation (range: −14°–−28°) in one 80 ° flexion to +23° after one month postop (range: 14°–32°). After two months, there were no instances of Trendelemburg sign or osteonecrosis of the femoral head.

Conclusions: We should wait to assess the pre-osteoarthritic development of these patients, although their clinical and functional improvement is evident.

The pathology of the posterior acetabular legion in femoroacetabular impingement (FAI) syndrome, so called “contre-coup region”, is still unclear. ¹⁸F-fluoride positron emission tomography (PET) is a functional imaging modality, which reflects the osteoblast activity. Recent technological advances in PET combined with computed tomography (CT) imaging allowed us to obtain detailed 3-dimensional (3D) morphological information. We evaluated the abnormal uptake of ¹⁸F-fluoride PET/CT on posterior acetabular lesion in FAI syndrome cases. We enrolled forty-one hips from 41 patients who were diagnosed as FAI syndrome and were performed ¹⁸F-fluoride PET/CT between October 2014 and October 2016. In each hip, the maximum standardized uptake value (SUV_max) on the posterior acetabular was measured. The cases were divided into 4 groups; cam-type (11 cases), pincer-type (7), combined-type (11), dysplastic developmental hip (DDH) with cam morphology (12). The average SUV_max of the pincer-type was significantly smaller than that of the other 3 groups (p < .05). The percentage of the cases with SUV_max ≥ 6 was 81.8% in cam-type, 28.6% in pincer-type, 90.9% in combined-type, 91.7% in DDH with cam morphology. Furthermore, the average degree of α angle of the cases of SUV_max ≥ 6 was significantly higher than that of the cases of SUV_max < 6 (p = .005). Although actual biomechanical mechanism in contre-coup region is still controversial, this result indicated that the cam morphology related to the posterior acetabular lesion with accelerated bone metabolism.

A retrospective review of the medical records, radiological studies, operative reports, and physiotherapy charts was done for 11 consecutive elite dancers (7 [64%] women and 4 [36%] men) who underwent arthroscopic treatment for anterior ankle impingement syndrome during a 9-year period (1990–1999). The procedures were performed by a single surgeon (DJR) at one hospital (Hospital for Joint Diseases). There were 14 arthroscopic procedures (12 initial and 2 repeat) involving the right ankle in 8 (57%) and the left ankle in 6 (43%). Average age (± standard deviation) at surgery was 28 ± 6 years (age range, 20–41 years). There were 6 (55%) professional dancers, 4 (36%) pre-professional dance students, and 1 (9%) professional dance teacher; all were primarily ballet dancers, but three concurrently performed modern dance.

In 6 (50%) ankles, soft tissue impingement only (hypertrophic synovitis or impinging distal fascicle of the inferior band of the anterior tibiofibular ligament) was noted, and in 6 (50%) ankles, a bony spur was also present on the anterior lip of the tibia and/or dorsal aspect of the talar neck. Resection of bony spurs and excision of hypertrophic soft tissue and synovium was performed arthroscopically. Nine (82%) of the 11 patients returned to dance after an average period of 7 weeks (range, 6 to 11 weeks). There were no wound infections or neuromas. One ankle with soft tissue impingement developed postoperative stiffness despite physical therapy, and underwent repeat arthroscopy 4 months after the initial procedure for excision of adhesions and scar tissue; this dancer subsequently returned to competitive dance. Another ankle had a second arthroscopic debridement for recurrent spur formation, 9 years after the first arthroscopic excision; this dancer retired from dance performance after the first arthroscopy because of concurrent knee and back problems, but he continued at a lower activity level as a dance teacher. In summary, arthroscopic debridement was effective in the management of anterior ankle impingement in dancers.

A modified Kessel trans-acromial approach has been utilised in our Unit for decompression and repair of associated rotator cuff tear for all advanced impingement syndrome (Stage III). This preliminary report aims to review our results, and to assess the complications of this approach.

From 1996 to 1999, 22 consecutive patients who were treated surgically using a Trans-acromial approach for advanced impingement syndrome, were reviewed. The diagnosis of impingement syndrome was based on history, physical examination and Lignocaine impingement test, with either an ultrasound scan, arthrogram, or MRI. The modified trans-acromial approach was used involving splitting and raising a periosteal soft tissue flap over the acromion, followed by splitting the acromion in the coronal plane just behind the acromioclavicular joint, this allowed an extensive exposure of the rotator cuff and easy undercutting of the acromion.

20 patients were interviewed and examined specifically for this study, for an average follow up of 17 months. The other two patients were interviewed by telephone. The following parameters were studied: 1) functional assessment:[Constant’s Scoring system, and the UCLA Shoulder rating Scale. 2) Pain relief. 3) Patient satisfaction. 5) Return to preoperative activity. 6) Complication. The results were satisfactory in 17 patients (77%), and unsatisfactory in 5 pt (23%), one of which had cervical spondolysis, and two had new bony formation in the subacromial space. Pain relief was achieved in 78%. All patients returned to their preoperative occupation apart from one. Two patients had persisting impingement and had undergone revision subacromial decompression with satisfactory results.

The modified trans-acromial approach is an acceptable alternative to open anterior acromioplasty. It offers adequate decompression of the sub-acromial space, allowing a wide exposure and excellent visualisation of the rotator cuff. This facilitates cuff repair and mobilisation, while maintaining the integrity of the deltoid muscle, which accelerates postoperative rehabilitation.

Introduction

Femoroacetabular impingement (FAI) causes anterior hip pain, labral tears and damage to the articular cartilage leading to early osteoarthritis of the hip. Surgical hip dislocation and osteoplasty of the femoral neck and acetabular rim is a technique pioneered by the Bernese group for the treatment of FAI. We present and discuss our results of this technique.

Introduction: Femoroacetabular impingement (FAI) causes anterior hip pain, labral tears and damage to the articular cartilage leading to early osteoarthritis of the hip. Surgical hip dislocation and osteoplasty of the femoral neck and acetabular rim is a technique pioneered by the Bernese group for the treatment of FAI. We present and discuss our results of this technique.

Methods: Functional outcome was measured using the Oxford hip and McCarthy non-arthritic hip scores pre and post-operatively.

Results: Since January 2003, 36 hips in 34 patients (average age of 43 years (14–65)) underwent surgical hip dislocation for treatment of FAI. In 9 hips, grade 4 osteoarthritis was present in greater than 10 x 10mm regions after reshaping of the abnormal anatomy. In these cases, hip resurfacing was performed.

Of the 27 hips preserved, 14 had chondral ‘carpet’ flaps debrided, 17 underwent recession of the acetabular rim at the site of impingement, 6 had removal of medial osteophytes, 6 had labral and/or bony cysts excised and grafted and 1 underwent an osteochondral graft.

Oxford Hip Score improved from an average 36 (range 17–59) to 23 (12–45) and McCarthy hip score from 43 (9–74) to 62 (36–72) in the preserved hips at an average 15 months following surgery (range 6–33 months).

Discussion: The early results of surgical hip dislocation are encouraging. Careful patient selection is important in order to exclude patients with hip osteoarthritis. Long-term follow-up is required to see if this technique prevents the natural progression to osteoarthritis.

Introduction: Femoro-acetabular impingement (FAI) causes anterior hip pain, labral tears and damage to the articular cartilage leading to early osteoarthritis of the hip. Surgical hip dislocation and osteoplasty of the femoral neck and acetabular rim is a technique pioneered by the Bernese group for the treatment of FAI. We present and discuss our results of this technique.

Methods: functional outcome was measured using the oxford hip and McCarthy non-arthritic hip scores pre and post-operatively.

Results: Since January 2003, 36 hips in 34 patients (average age of 43 years (14–65)) underwent surgical hip dislocation for treatment of FAI. In 9 hips, grade 4 osteoarthritis was present in greater than 10 x 10mm regions after reshaping of the abnormal anatomy. In these cases, hip resurfacing was performed.

Of the 27 hips preserved, 14 had chondral ‘carpet’ flaps debrided, 17 underwent recession of the acetabular rim at the site of impingement, 6 had removal of medial osteophytes, 6 had labral and/or bony cysts excised and grafted and 1 underwent an osteochondral graft.

In 3 hips (12%) osteoarthritis progressed requiring hip resurfacing within the first year.

Oxford Hip Score improved from an average 36 (range 17–59) to 23 (12–45) and McCarthy hip score from 43 (9–74) to 62 (36–72) in the preserved hips at an average 15 months following surgery (range 6–33 months).

Discussion: The early results of surgical hip dislocation are encouraging. The open procedure has distinct advantages compared to arthroscopy enabling a wider range of lesions to be treated. Careful patient selection is important in order to exclude patients with hip osteoarthritis. Long-term follow-up is required to see if this technique prevents the natural progression to osteoarthritis

Introduction The aims of this paper was to check the main clinical features of the posterior ankle impingment syndrom and to evaluate the results of the surgical treatment according to a retrospective study. Material and Methods 21 patients (17 males,4 females),(mean age of 33 years)were operated on between 1991 and 1999. 71 % had sporting activities. Plantar flexion were painful in 94 % of cases with various radiological changings of the posterior process of the talus and soft tissues surrounded (XRays, radionucleid imaging, CTscan and MRI). A posterior approach were performed with bone resection and peritalar joints debridment. Results All the patients were clinically and radiologically reviewed using AOFAS score. The mean follow-up was of 5 years(range 3 to 10 years). No septic evolution were reported. The overall functional results were excellent with a mean AOFAS score of 90/100 points with no degenerative changings in the peritalar joints. The patients were satisfied in 90 % of the cases Discussion-Conclusion Surgical managment is a successful and reliable procedure to treat the posterior ankle impingment syndrom, very frequent in sporting population and nowadays well documented by conventional Xrays and uptodate radiological examinations.

68 patients underwent arthroscopic subacromial decompression for shoulder impingement syndrome. Patients were evaluated preoperatively, at 3 weeks and 3 months post operatively using the Constant score. Mean preoperative Constant score was 46. 5 (34–67), at 3 weeks 65. 8 (40–86), and at 3 months 82. 4 (50–99). There was no correlation between the impingement grade, presence of a cuff tear or acromioclavicular joint involvement, and a significant poorer outcome. Arthroscopic subacromial decompression is a reliable method of improving the functional ability of patients with subacromial impingement syndrome, with a 20 point increase in the Constant score at 3 weeks post surgery, rising to a 40 point increase at 3 months. Patients can therefore be counselled that they will make a significant functional improvement in a short time after surgery.

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

Patients with subacromial impingement syndrome were identified. Those who had not previously had any physiotherapy and had failed to respond to non-surgical management were selected and placed on the waiting list for subacromial decompression.

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 arm underwent assessment and treatment by a single physiotherapist.

All patients were evaluated independently at 3 and 6 months. The Constant Score was used to assess all patients initially and at each visit.

Physiotherapy group: All patients (n=42) increased their Constant score. 11 of the 42 patients improved to an extent that surgery was no longer required (26%). In patients not requiring surgery, the mean improvement in Constant score was 25 (12–45) In patients requiring surgery (n=31), the mean improvement was 21 (3–34).

Patients not requiring surgery had a higher initial Constant score, 65 (30–84) than those requiring surgery 48 (17–59). Patients not requiring surgery also tended to be younger 52 (27–68) than those requiring surgery 59 (48–68).

Control group: All patients (n=23) went on to have surgery.

The mean improvement in Constant score was 2 (−16 to 12).

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

Arthroscopic subacromial decompression for shoulder impingement syndrome is one of the commonest procedures performed by the shoulder surgeon. Although much has been written on this procedure since Ellman published in 1985, very little work has been carried out on the rate of recovery after surgery, despite this being one of the main concerns of the patient. This prospective study describes the early functional results after this procedure and the rate of recovery seen.

Sixty-eight patients underwent arthroscopic subacromial decompression for shoulder impingement syndrome between January and November 2000. All patients had suffered pain for at least six months prior to surgery, and all were diagnosed on the basis of clinical findings, radiographic evidence, and a positive response to Neer’s impingement test, i.e. abolition of pain after an injection of local anaesthetic into the subacromial space. All patients were evaluated preoperatively, at three weeks and three months post operatively using the Constant score to obtain an objective assessment of shoulder function. Surgery was carried out via an arthroscopic technique using the Dyonics power shaver with the 4.5 mm Helicut blade (Smith & Nephew). Immediate post operative physiotherapy was allowed, together with the encouragement of activities of daily living.

Sixty-eight patients with a mean age of 45 years (range: 30–77 years) underwent surgery over a 10 month period. Male: female ratio was 60:40, and the lateral clavicle was affected in 33 cases, resulting in the need for an acromioclavicular joint resection to be performed arthroscopically at the same sitting. Mean preoperative Constant score was 46.5 (34–67), at three weeks 65.8 (40–86), and at three months 82.4 (50–99). Sixty-five out of 68 patients returned to full activities, including heavy manual work where necessary, by three month review. There was no correlation between the impingement grade, presence of a cuff tear, or acromioclavicular joint involvement, and a significantly poorer outcome. In particular, no patient was made worse by surgery, and at the latest review of the cohort the improvement seen has not deteriorated.

Arthroscopic subacromial decompression is a reliable method of improving the functional ability of patients with subacromial impingement syndrome, with a 20 point increase in the Constant score at three weeks post surgery, rising to a 40 point increase at three months. Patients can therefore be counseled that they will make a significant functional improvement in a short time after surgery.

The purpose of this study was to assess the value of physiotherapy in the treatment of patients with subacromial impingement syndrome

Patients with subacromial impingement syndrome were identified. Those who had not previously had any physiotherapy and had failed to respond to non-surgical management were selected and placed on the waiting list for subacromial decompression. 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 arm underwent assessment and treatment by a single physiotherapist. All patients were evaluated independently at three and six months. The Constant Score was used to assess all patients initially and at each visit.

For the physiotherapy group, all patients (n=42) increased their Constant score. Eleven of the 42 patients improved to an extent that surgery was no longer required (26%). In patients not requiring surgery, the mean improvement in Constant score was 25 (12–45). In patients requiring surgery (n=31), the mean improvement was 21 (3–34). Patients not requiring surgery had a higher initial Constant score, 65 (30–84) than those requiring surgery 48 (17–59). Patients not requiring surgery also tended to be younger 52 (27–68) than those requiring surgery 59 (48–68).

For the control group, all patients (n=23) went on to have surgery. The mean improvement in Constant score was two (−16 to 12)

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