From the Guidelines
Treatment for Subacromial Impingement Syndrome should prioritize conservative measures, including rest, activity modification, and physical therapy, with surgery reserved for cases that don't respond to 6+ months of conservative management. This approach is supported by the most recent and highest quality study, which highlights the importance of non-operative care and the limited evidence for the effectiveness of surgical interventions 1. The study notes that surgery is expensive and associated with considerable morbidity, increased risk of complications, and excess mortality, making it essential to exhaust non-operative options before considering surgical intervention.
Key components of conservative management include:
- Physical therapy focusing on rotator cuff strengthening, scapular stabilization, and proper shoulder mechanics, performed 2-3 times weekly for 6-8 weeks
- Pain management with NSAIDs, such as ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily), for 1-2 weeks
- Ice application to the affected shoulder for 15-20 minutes several times daily to reduce inflammation
- Temporary avoidance of overhead activities and movements that cause pain
If these measures don't provide adequate relief, a corticosteroid injection (such as 40mg methylprednisolone with local anesthetic) into the subacromial space may be beneficial, though typically limited to 2-3 injections per year. However, the evidence for the effectiveness of corticosteroid injections is conflicting, and their use should be carefully considered on a case-by-case basis 1. Most patients improve with conservative treatment within 3-6 months, and surgery (subacromial decompression) should only be considered for cases that don't respond to prolonged conservative management.
From the Research
Treatment Options for Subacromial Impingement Syndrome
The treatment for Subacromial Impingement Syndrome includes:
- Conservative management, such as physical therapy, nonsteroidal anti-inflammatory drugs, and subacromial injections 2
- Exercise packages, which can be standardised or individualised and progressed 3
- Corticosteroid injection, which can be administered with or without the use of musculoskeletal ultrasound to guide the injection 3
- Rotator cuff and scapula strengthening exercises for at least three months as the initial non-operative treatment 4
- Rest, ice packs, and physical therapy as part of conservative treatment 5
Effectiveness of Physiotherapy and Manual Therapy
There is moderate evidence for the effectiveness of:
- Hyperthermia compared to exercise therapy or ultrasound in the short term 6
- Hyperthermia and exercise therapy compared to controls or placebo in the short term 6
- Exercise therapy in the midterm compared to placebo or controls 6
Non-Surgical Interventions
Non-surgical treatment is used to:
- Reduce pain 6
- Decrease subacromial inflammation 6
- Heal the compromised rotator cuff 6
- Restore satisfactory function of the shoulder 6
Referral to Orthopaedic Specialist
Patients with persistent symptoms after sufficiently tried non-operative treatment should be referred to an orthopaedic specialist 4