Analysis of the conservative treatment efficacy in patients with subacromial impingement syndrome


Purpose: to evaluate the efficacy of the conservative treatment of patients with subacromial impingement syndrome (SIS) and supraspinatus muscle tendon (SMT) pathology using optimized clinical and beam algorithm. Patients and methods. Complex evaluation of the conservative treatment efficacy (physiotherapeutic treatment (PHT), exercise therapy (ET), shockwave therapy (SWT)) was performed in 128 patients - 67 (52.3%) men, 61 (47.7%) women with SIS. Mean age of patients was 59±8 years (24 - 82 yrs), follow up period - 9.6 ±5.6 months (maximum 18 mos). All patients underwent optimized complex clinical and beam examination. Treatment efficacy was evaluated in dynamics at terms 3, 6 and 9 months. Dynamics of pain syndrome and structural changes in STM regress was assessed depending on the type of treatment with calculation of correlation coefficient. Results. In 3 months positive effect of conservative treatment was noted in 67 (65%), in 6 months - in 78 (77%) and in 9 months - in 84 (82%) patients. High correlation of data obtained using the elaborated pain scale for a shoulder with the visual analogue scale data at treatment monitoring (r=0,89) as well as with the monitoring US data (r=0,94) was determined. The combination of SWT+ET+PHT or SWT+PHT showed good therapeutic effect in 3 months after treatment and by 6th month excellent result was recorded in 85% of cases. Due to the long rehabilitation period in operated patients in 3 and 6 months after intervention only the satisfactory result with mean point 3.02±0.12 and 3.52±0.14 respectively was achieved. Conclusion. Choice of treatment method should be based on the results of complex clinical beam examination. In patients with SIS and SMT pathology the most effective is a combined conservative treatment with SWT+ET+PHT or SWT+PHT. However a conservative treatment efficacy is significantly influenced by the SIS stage, anatomical structure of acromeonon as well as the type of SMT structural changes.

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About the authors

Mikhail V. Emel’yanenko

Central Clinical Hospital with Outpatient Polyclinic, Administration of President of the Russian Federation

Moscow, Russia
Cand. med. sci., trauma and orthopaedic surgeon, Central Clinical Hospital with Outpatient Polyclinic

F. L Lazko

Central Clinical Hospital with Outpatient Polyclinic, Administration of President of the Russian Federation

Moscow, Russia

V. E Gazhonova

Central Clinical Hospital with Outpatient Polyclinic, Administration of President of the Russian Federation

Moscow, Russia

I. V Krivoshey

Central Clinical Hospital with Outpatient Polyclinic, Administration of President of the Russian Federation

Moscow, Russia


  1. Singh B., Bakti N., Gulihar A. Current concepts in the diagnosis and treatment of shoulder impingement. Indian J. Orthop. 2017; 51 (5): 516-23. doi: 10.4103/ortho.IJOrtho_187_17.
  2. Nazligul T., Akpinar P., Aktas I. et al. The effect of interferential current therapy on patients with subacromial impingement syndrome: a randomized, double-blind, sham-controlled study. Eur. J. Phys. Rehabil. Med. 2017. doi: 10.23736/S1973-9087.17.04743-8.
  3. Dalbøge A., Frost P., Andersen J.H., Svendsen S.W. Surgery for subacromial impingement syndrome in relation to intensities of occupational mechanical exposures across 10-year exposure time windows. Occup. Environ. Med. 2018; 75 (3): 176-182. doi: 10.1136/oemed-2017-104511.
  4. Steuri R., Sattelmayer M., Elsig S. et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br. J. Sports Med. 2017; 51 (18): 1340-7. doi: 10.1136/bjsports-2016-096515.
  5. Paavola M., Malmivaara A., Taimela S. et al.; FIMPACT Investigators. Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT): a protocol for a randomised trial comparing arthroscopic subacromial decompression and diagnostic arthroscopy (placebo control), with an exercise therapy control, in the treatment of shoulder impingement syndrome. BMJ Open. 2017; 7 (5): e014087. doi: 10.1136/bmjopen-2016-014087.
  6. Hawk C., Minkalis A.L., Khorsan R. et al. Systematic review of nondrug, nonsurgical treatment of shoulder conditions. J. Manipulative Physiol. Ther. 2017; 40 (5): 293-319. doi: 10.1016/j.jmpt.2017.04.001.
  7. Kolk A., Thomassen B.J.W., Hund H. et al. Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A double-blinded randomized clinical trial with 9 to 14 years' follow-up. J. Shoulder Elbow Surg. 2017; 26 (8): 1407-15. doi: 10.1016/j.jse.2017.03.021.
  8. Bigliani L., Morrison D., April E. The morphology of the acromion and its relationship to rotator cuff tears. Orthop. Trans. 1986; 10: 216.
  9. Cuff A., Littlewood C. Subacromial impingement syndrome - What does this mean to and for the patient? A qualitative study. Musculoskelet. Sci Pract. 2017; 33: 24-8. doi: 10.1016/j.msksp.2017.10.008.
  10. Garving C., Jakob S., Bauer I. et al. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017; 114 (45): 765-76. doi: 10.3238/arztebl.2017.0765.
  11. Alizadehkhaiyat O., Roebuck M.M., Makki A.T., Frostick S.P. Postural alterations in patients with subacromial impingement syndrome. Int. J. Sports Phys. Ther. 2017; 12 (7): 1111-20.
  12. Watts A.R., Williams B., Kim S.W. et al. Shoulder impingement syndrome: a systematic review of clinical trial participant selection criteria. Shoulder Elbow. 2017; 9 (1): 31-41. doi: 10.1177/1758573216663201.
  13. Neer C.S. Jr. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J. Bone Joint Surg. Am. 1972; 54: 41-50.
  14. Neer C.S. Jr, Welsh R.P. The shoulder in sports. Orthop. Clin. North Am. 1977; 8: 583-91.
  15. Neer C.S. 2nd. Impingement lesions. Clin. Orthop. Relat. Res. 1983; (173): 70-7.
  16. Neer C.S. 2nd. The components of our global exchange on surgery of the shoulder. J. Shoulder Elbow Surg. 1995; 4: 477-80.
  17. Альримави М.Х., Маланин Д.А., Соломин М.Ю., Тетерин О.Г. Оценка результатов лечения больных плечелопаточным болевым синдромом с использованием опросников. Бюллетень Волгоградского научного центра РАМН. 2006; 4: 37-40.
  18. Bicer A., Ankarali H. Shoulder pain and disability index: a validation study in Turkish women. Singapore Med. J. 2010; 51 (111): 865-70.
  19. Bigliani L.U., Ticker J.B., Flatow E.L. et al. The relationship of acromial architecture to rotator cuff disease. Clin. Sports Med. 1991; 10 (4): 823-38.
  20. Rutten M.J., Spaargaren G.J., van Loon T. et al. Detection of rotator cuff tears: the value of MRI following ultrasound. Eur. Radiol. 2010; 20 (2): 450-7. doi: 10.1007/s00330-009-1561-9.
  21. Гажонова В.Е., Емельяненко М.В. Онищенко М.П. и др. Оптимизация лучевого алгоритма при патологии сухожилия надостной мышцы плечевого сустава. Кремлевская медицина. Клинический вестник. 2017; 3: 35-44.
  22. Dong W., Gost H., Lin X. et al. Treatment for shoulder impingement syndrome. Medicine (Baltimore). 2015; 94 (10): e510. doi:10/1097/MD.0000000000000510.
  23. Engebretsen K., Grotle M., Bautz-Holter E. et al. Supervised exercises compared with radial extracorporeal shock-wave therapy for subacromial shoulder pain: 1-year results of a single-blind randomized controlled trial. Phys. Ther. 2011; 91 (1): 37-47. doi: 10.2522/ptj.20090338.
  24. Ketola S., Lehtinen J., Arnala I. et al. Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome? A two-year randomised controlled trial. J. Bone Joint Surg. Br. 2009; 91 (10): 1326-34. doi: 10.1302/0301-620X.91B10.22094.
  25. Gebremariam L., Hay E.M., Koes B.W., Huisstede B.M. Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review. Arch. Phys. Med. Rehabil. 2011; 92 (11): 1900-13. doi: 10.1016/j.apmr.2011.06.006.
  26. Donigan J.A., Wolf B.R. Arthroscopic subacromial decompression: acromioplasty versus bursectomy alone-does it really matter? A systematic review. Iowa Orthop. J. 2011; 31: 121-6.
  27. Brox J.I., Staff P.H., Ljunggren A.E., Brevik J.I. et al. Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome). BMJ. 1993; 307 (6909): 899-903.
  28. Li X., Xu W., Hu N. et al. Relationship between acromial morphological variation and subacromial impingement: A three-dimensional analysis. PLoS One. 2017; 12 (4): e0176193. doi: 10.1371/journal.pone.0176193.



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