Current UK practices in the management of subacromial impingement

Abstract

Background

Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients.

Methods

BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons.

Results

Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation.

Conclusions

Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections.

Keywords

Acromioplasty arthroscopic decompression subacromial impingement

Get full access to this article

View all access options for this article.

References

Haahr

Ostergaard

Dalsgaard

. 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: 760–4.

Mohadi

. Exercises or arthroscopic decompression for subacromial impingement? Clin J Sport Med 2006; 16: 193–4.

Brox

Gjengedal

Uppheim

. Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome); a prospective, randomized, controlled study in 125 patients with a 2½ year follow-up. J Shoulder Elbow Surg 1999; 8: 102–11.

Nutton

McBirnie

Phillips

. Treatment of chronic rotator cuff impingment by arthroscopic subacromial decompression. J Bone Joint Surg [Br] 1997; 79B: 73–6.

Morrison

Frogameni

Woodworth

. Non-operative treatment of subacromial impingment syndrome. J Bone Join Surg [Am] 1997; 79A: 732–7.

Coghlan

Buchbinder

Green

. Surgery for rotator cuff disease. Cochrane Database Syst Rev 2008; 1: CD005619–CD005619.

Murphy RJ, Maxwell R, Kulkarni R, et al. Rates of arthroscopic subacromial decompression and rotator cuff repair surgery in the NHS in England from 2000 to 2010 [abstract]. In Procs Bess Congress, 2011.

Johansson

Oberg

Adolfsson

Foldevi

. A combination of systematic review and clinicians’ beliefs in interventions for subacromial pain. Br J Gen Pract 2002; 52: 145–52.

Gebremariam

Hay

van der Sande

. Subacromial impingement syndrome – effectiveness of physiotherapy and manual therapy. Br J Sports Med 2014; 48: 1202–8.

10.

Hanratty

McVeigh

Kerr

. The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Semin Arthritis Rheum 2012; 42: 297–316.

11.

Henkus

Lodewijck

Cobben

. The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study. J Arthroscopic Rel Surg 2006; 22: 277–82.

12.

Esenyel

Yesiltepe

. The correlation between the accuracy of steroid injection and subsequent shoulder pain and function in subacromial impingement syndrome. Acta Orthop Traumatol Turc 2003; 37: 41–5.

13.

Kang

Rizio

Prybicien

Middlemas

Blacksin

. The accuracy of subacromial corticosteroid injections: a comparison of multiple methods. J Shoulder Elbow Surg 2008; 17.1: S61–66.

14.

Cholewinski

Kusz

Wojciechowski

Cielinski

Zoladz

. Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder. Knee Surg Sports Traumatol Arthrosc 2008; 16: 408–14.

15.

Lim

Acornley

Dodenhoff

. Recovery after arthroscopic subacromial decompression: prognostic value of the subacromial injection test. Arthroscopy 2005; 21: 680–3.

16.

Patel

Singh

Calvert

Bayley

. Arthroscopic subacromial decompression: results and factors affecting outcome. J Shoulder Elbow Surg 1999; 8: 231–7.

17.

Singh

Mehta

Pandey

. A preoperative scoring system to select patients for arthroscopic subacromial decompression. J Shoulder Elbow Surg 2014; 23: 1251–6.

18.

Al-Kaisy

McGuire

Chan

. Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery. Reg Anesth Pain Med 1998; 23: 469–73.

19.

Krone

Chan

Regan

. Analgesic effects of low dose ropivacaine for interscalene brachial plexus block for outpatient shoulder surgery – a dose finding study. Reg Anesth Pain Med 2001; 26: 439–43.

20.

Laurila

Lopponen

Kangas-Saarela

Flinkkila

Salomaki

. Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery. Acta Anaesthesiol Scand 2002; 46: 1031–6.

21.

Nisar

Aamer

Morris

Freeman

Cort

Rayner

Shahane

. Subacromial bursa block is an effective alternative to interscalene block for postoperative pain control after arthroscopic subacromial decompression: a randomized trial. J Shoulder Elbow Surg 2008; 17: 78–84.

22.

Henkus

de Witte

Nelissen

. Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study. J Bone Joint Surg [Br] 2009; 91: 504–10.