Shoulder injuries are common and often referred for treatment through surgical means. Researchers compared surgery vs. exercise training in patients suffering from shoulder pain to determine which has the more positive outcome. Shoulder pain in this study was defined as rotator cuff disease and nerve impingement.
Eighty-four participants were randomized into a surgical intervention group (41 patients) or physiotherapeutic exercise group (43 patients). All patients were evaluated before intervention and filled out a questionnaire regarding pain and impairment. The exercise group received 19, 60-minute sessions consisting of the application of heat, cold packs, or soft-tissue treatments, followed by muscle training and rotator cuff strengthening exercises.
Results: Both groups were evaluated at three, six and 12 months. Pain was measured using the Constant score totaling 100, which includes pain measured on a visual analogue scale, as well as measures in daily activity limitations, range of motion and shoulder strength. Before intervention, the exercise group Constant score was 34.8, while the surgery group was 33.7. After intervention, the exercise group Constant score improved to 54.8, 55.5, and 57.0 after three, six and 12 months, respectively, while the surgery group’s scores were 49.2, 53.8 and 52.7. After one year, 20 participants (10 in each group) reported a score of 80 or higher.
Although the researchers note some study limitations, they ultimately concluded that they “are now more reluctant to recommend surgery" for shoulder impingement.
Haahr JP, Østergaard S, Dalsgaard J, et al. Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis 2005;64:760-764.