Introduction and Aims: To establish how effective conservative treatment is for rotator cuff impingement. To look at the clinical presentation and the factors that influences the outcome.

Method: A retrospective study of 189 patients, who attended the Upper Limb Clinic, was done. The response to physiotherapy and cortisone injections was noted. We also looked at the shape of the acromion and tried to correlate it with effectiveness of conservative treatment.

Results: All patients had either a positive Neer or Hawkins sign. What is more significant is that in 123 patients internal rotation was markedly restricted to the 10^th dorsal vertebrae or less. One hundred and nineteen patients received a sub-acromial cortisone injection. It was repeated in 52 patients, and 25 patients received a third injection. Forty-four patients needed surgery. Therefore, conservative treatment was effective in 83% of cases. Of the group who was operated on, only nine patients had a large spur and only 12 patients had a Bigliani Type-III acromion. It does not seem as if the spur is the main cause for impingement.

Conclusion: Conservative treatment is very effective in the treatment of rotator cuff impingement. However, we believe that the right exercise program is of essence. Stretching the posterior capsule of the shoulder joint and increasing the internal rotation, which are the two most important initial exercises, should be concentrated on. Thereafter the depressor muscles, like sub-scapularis and infra-spinatus must be strengthened.

Our retrospective study of 189 patients aimed to establish the efficacy of conservative treatment for rotator cuff impingement and also to assess the clinical presentation and the factors that influence the outcome.

We noted patients’ response to physiotherapy and cortisone injections. We looked at the shape of the acromion and tried to correlate it with effectiveness of conservative treatment.

All patients had either a positive Neer or Hawkins sign. In 123 patients internal rotation was markedly restricted. Subacromial cortisone injections were administered to 119 patients. The injection was repeated once in 52 patients and twice in 25. Surgery was necessary in 44 patients. In other words, conservative treatment was effective in 83%.

Only 12 of the patients who underwent surgery had a Bigliani type-III acromion and only nine had a large spur.

An appropriate exercise programme is critical if conservative treatment is to be effective. It should focus first on stretching the posterior capsule of the shoulder joint and increasing internal rotation, and subsequently on strengthening the subscapularis and infraspinatus muscles. We believe it is the imbalance of muscle power rather than the acromial spur that is the major cause of impingement.