review · British Journal of Sports Medicine
Subacromial impingement syndrome encompasses rotator cuff conditions, tendonitis, and bursitis of the shoulder. Non-surgical management aims to ease pain, minimise inflammation, promote tissue healing, and restore shoulder movement. A systematic review examined two prior reviews and ten randomised controlled trials assessing physiotherapy and manual therapy interventions. Moderate evidence indicates that exercise therapy and hyperthermia are more effective than control or placebo treatments in the short term. Furthermore, hyperthermia showed greater short-term effectiveness than exercise therapy or ultrasound, though its longer-term effects remain unexamined. In the midterm, exercise therapy provided the strongest outcomes compared to control groups. Evidence for alternative modalities, including ultrasound, laser therapy, pulsed electromagnetic fields, and manual therapy, proved conflicting, limited, or absent. While specific physical therapies show promise, further high-quality research is required to establish definitive treatment protocols.
Subacromial impingement syndrome is a common and debilitating shoulder condition that limits mobility and causes chronic pain. Identifying which non-surgical interventions genuinely work helps clinicians, physiotherapists, and patients select evidence-based treatments, avoiding costly or ineffective therapies while prioritising approaches such as structured exercise therapy that demonstrate verifiable therapeutic benefits over time.
The findings offer guidance for healthcare providers, clinical rehabilitation clinics, and physiotherapy practitioners selecting non-surgical treatment pathways for shoulder injuries. The research evaluates established clinical practices and physical modalities rather than novel proprietary technologies, meaning the evidence is already at the applied clinical level. However, commercial adoption and standardised protocol development for modalities like hyperthermia require further clinical trial validation of long-term patient outcomes.
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BACKGROUND: The subacromial impingement syndrome (SIS) includes the rotator cuff syndrome, tendonitis and bursitis of the shoulder. Treatment includes surgical and non-surgical modalities. Non-surgical treatment is used to reduce pain, to decrease the subacromial inflammation, to heal the compromised rotator cuff and to restore satisfactory function of the shoulder. To select the most appropriate non-surgical intervention and to identify gaps in scientific knowledge, we explored the effectiveness of the interventions used, concentrating on the effectiveness of physiotherapy and manual therapy. METHODS: The Cochrane Library, PubMed, EMBASE, PEDro and CINAHL were searched for relevant systematic reviews and randomised clinical trials (RCTs). Two reviewers independently extracted data and assessed the methodological quality. A best-evidence synthesis was used to summarise the results. RESULTS: Two reviews and 10 RCTs were included. One RCT studied manual therapy as an add-on therapy to self-training. All other studies studied the effect of physiotherapy: effectiveness of exercise therapy, mobilisation as an add-on therapy to exercises, ultrasound, laser and pulsed electromagnetic field. Moderate evidence was found for the effectiveness of hyperthermia compared to exercise therapy or ultrasound in the short term. Hyperthermia and exercise therapy were more effective in comparison to controls or placebo in the short term (moderate evidence). For the effectiveness of hyperthermia, no midterm or long-term results were studied. In the midterm, exercise therapy gave the best results (moderate evidence) compared to placebo or controls. For other interventions, conflicting, limited or no evidence was found. CONCLUSIONS: Some physiotherapeutic treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn.
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DOI: 10.1136/bjsports-2012-091802
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