From the Guidelines
The initial management for subacromial impingement syndrome should focus on conservative measures, including rest, activity modification, NSAIDs, and physical therapy, as these approaches have been shown to be effective in reducing symptoms and improving quality of life 1. The goal of treatment is to reduce inflammation, relieve pain, and improve function. Patients should temporarily avoid overhead activities and movements that provoke pain.
- NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks can help reduce inflammation and pain.
- Physical therapy is crucial and should include exercises to strengthen the rotator cuff muscles and scapular stabilizers, along with stretching to improve flexibility.
- A typical program involves 2-3 sessions weekly for 6-8 weeks, with home exercises performed daily.
- Ice can be applied to the affected shoulder for 15-20 minutes several times daily to reduce inflammation. It is essential to note that subacromial corticosteroid injections and surgical interventions, such as arthroscopic subacromial decompression, have been found to have limited benefits in terms of pain, function, and quality of life compared to conservative measures 1. Therefore, a comprehensive approach emphasizing conservative management is recommended as the initial treatment plan for subacromial impingement syndrome.
From the Research
Initial Management for Subacromial Impingement Syndrome
The initial management for subacromial impingement syndrome includes non-surgical modalities such as physiotherapy and manual therapy 2. The goal of non-surgical treatment is to reduce pain, decrease subacromial inflammation, heal the compromised rotator cuff, and restore satisfactory function of the shoulder.
Non-Surgical Interventions
Some of the non-surgical interventions used to manage subacromial impingement syndrome include:
- Physiotherapy: Moderate evidence was found for the effectiveness of hyperthermia compared to exercise therapy or ultrasound in the short term 2.
- Manual therapy: One study found that manual therapy as an add-on therapy to self-training was effective in managing subacromial impingement syndrome 2.
- Exercise therapy: Exercise therapy was found to be effective in the midterm, giving the best results compared to placebo or controls 2.
- Corticosteroid injections: Corticosteroid injections were found to be effective in reducing pain and improving function, but patients who received injections had more visits to their primary care provider and required additional injections 3.
- Handgrip-strengthening exercises: Adding handgrip-strengthening exercises to conventional intervention was found to increase the efficacy of treatment for patients with primary subacromial impingement syndrome 4.
Surgical Intervention
Surgical intervention may be considered for some patients with subacromial impingement syndrome, but the majority of studies showed no difference in outcome between patients who underwent surgical decompression and those who received conservative management 5. However, some studies reported better results after surgery, especially in the long term.
Key Findings
Key findings from the studies include:
- Physiotherapy and manual therapy are effective non-surgical interventions for managing subacromial impingement syndrome 2.
- Corticosteroid injections can be effective in reducing pain and improving function, but may require additional interventions 3.
- Handgrip-strengthening exercises can increase the efficacy of treatment for patients with primary subacromial impingement syndrome 4.
- Surgical intervention may be considered for some patients, but more research is needed to understand its role in managing subacromial impingement syndrome 5.