The treatment of subacromial impingement syndrome remains a controversial entity among both primary care physicians and orthopaedic surgeons. The initial management of this disorder is usually conservative with directed physiotherapy, subacromial corticosteroid injections and nonsteroidal anti-inflammatories representing the mainstays of treatment. Surgery in the form of arthroscopic bursectomy or acromioplasty is reserved for those patients who fail at least 6 months of conservative management. Traditionally, there have been few high-level studies to guide the practitioner concerning when conservative treatment has failed, which patients are candidates for surgical intervention or which surgical intervention may be most appropriate for a particular patient. However, recent studies have improved our knowledge base of the pathophysiology underlying this disorder and they provide some useful guidance on the conservative and operative management of this complex problem.
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