Non-surgical treatment may be just as effective for shoulder pain

No strong evidence to support surgery as a superior option

Shoulder impingement syndrome is one of the most common sources of shoulder pain and often occurs as the result of too much overhead activity like painting, tennis or baseball. Pain from shoulder impingement can restrict many daily activities and usually requires treatment. Many treatment options are available for the condition, but they can all be generally categorized as either surgical or non-surgical (conservative). Though many physicians recommend surgery in certain cases, there is no strong evidence to support it as a superior choice over conservative treatment. To investigate this matter more closely and compare the two options, a systematic review and meta-analysis (the most powerful type of studies that produce the most accurate answers) were conducted.

Specific guidelines used to extract only quality evidence

To find relevant data, five major medical databases were searched. To ensure only high-quality evidence was reviewed, inclusion criteria were applied to potential candidates. The criteria required that all studies were randomized-controlled trials (RCTs), one of the strongest types of research, on shoulder impingement that evaluated pain intensity or frequency. Seven RCTs fit the criteria and were used in the review/meta-analysis. The types of conservative treatment varied but mainly consisted of exercise-training programs designed by physical therapists.

Based on evidence, conservative treatment is strongly recommended over surgery

On the whole, the meta-analysis found that conservative and surgical treatment led to similar outcomes for patients with shoulder impingement syndrome. No evidence was found to support surgery as superior to conservative treatment, and moderate evidence was found that showed surgery was no more effective than active exercise for reducing pain intensity. Regarding treatment costs, surgery was estimated to cost nearly twice as much as conservative treatment, and it was also associated with a high risk of complications. Based on this, with no apparent added benefits and a higher cost and risk for complications, surgery should only be considered after a course of conservative treatment methods fail. Though more research is needed to further confirm this, current research shows that conservative treatment is a viable and evidence-supported first option for shoulder impingement that will save patients money and reduce the risk of additional problems.

-As reported in the April '14 edition of Disability and Rehabilitation
December 21, 2014
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