What are the treatment options for Shoulder Impingement Syndrome in pediatric patients?

From the Guidelines

Treatment of shoulder impingement syndrome in pediatric patients should begin with conservative management, including rest, activity modification, and physical therapy, as surgical intervention is associated with considerable morbidity and increased risk of complications 1.

Conservative Management

Conservative management is the preferred initial treatment approach for shoulder impingement syndrome in pediatric patients. This includes:

• Rest and activity modification to reduce stress on the affected shoulder
• Physical therapy to strengthen the rotator cuff muscles, improve scapular stability, and correct biomechanical issues that may contribute to impingement
• Pain management with acetaminophen (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) or ibuprofen (10 mg/kg every 6-8 hours with food) for short periods
• Ice application for 15-20 minutes several times daily to reduce inflammation, especially after activities

Physical Therapy

Physical therapy is a crucial component of conservative management. A short course of physical therapy for 6-8 weeks is recommended, with sessions 2-3 times weekly focusing on:

• Posterior capsule stretching
• Rotator cuff strengthening
• Scapular stabilization exercises Home exercise programs should be continued daily to maintain progress and prevent recurrence.

Surgical Intervention

Surgical intervention is extremely uncommon in children and only considered after failed conservative treatment lasting at least 6-12 months 1. The use of arthroscopic subacromial decompression is not recommended due to limited evidence of its clinical effectiveness 1.

Additional Considerations

Corticosteroid injections are rarely used in pediatric patients due to concerns about growth plate damage and tissue weakening. Addressing training techniques and implementing appropriate rest periods is crucial for recovery and prevention of recurrence, especially in pediatric patients who participate in sports like swimming or baseball.

From the Research

Treatment Options for Shoulder Impingement Syndrome in Pediatric Patients

There are no specific studies provided that focus on the treatment options for shoulder impingement syndrome in pediatric patients. However, the available evidence on treatment options for shoulder impingement syndrome in general can be considered:

• Nonoperative Treatments:
  • Exercise therapy is a recommended treatment for shoulder impingement syndrome 2, 3, 4
  • Combined treatments composed of exercise and other therapies tend to yield better effects than single-intervention therapies 4
  • Localized drug injections combined with exercise may show better treatment effects than injections used alone 4
• Manual Physical Therapy:
  • Manual physical therapy has been shown to be effective in improving symptoms, including decreasing pain and improving function 5, 3
• Surgical Treatments:
  • Arthroscopic subacromial decompression (ASD) may be considered for patients with a long-term disease course, with standard ASD surgery preferred over arthroscopic bursectomy and the open surgical technique for subacromial decompression 4
• Other Treatments:
  • Anti-inflammatory medications and injections may be used as part of the treatment algorithm 6
  • Physical therapy, including exercises and stretches, is a mainstay of treatment 6

It is essential to note that these treatment options are based on studies that may not specifically focus on pediatric patients, and the effectiveness of these treatments may vary depending on the age and specific condition of the patient.