How to Get Yourself Off a Shoulder Surgical Wait List.


Watch the video below to discover more about the positive effects of a specific shoulder exercise program to potentially decrease your need for shoulder surgery. The truth is in this case even non specific exercise made a difference for some.
Subacromial impingement syndrome is a condition in which the internal structures of the shoulder are impinged or compressed most commonly between the humeral head (ball) and the undersurface of the acromion (a bony extension of the shoulder blade). This condition may come about due to dysfunction within of a number of important structures in and around the shoulder girdle.

It most commonly occurs when painful injury to the muscles of the rotator cuff renders them incapable of stabilising the humeral head in the glenoid socket. As a consequence the humeral head rises upwards towards the undersurface of the acromion compressing the rotator cuff tendons and the overlying bursa. Other factors can increase a person’s risk of shoulder impingement, for example poor shoulder balde control, muscle fatigue and soft tissue tightness especially of the posterior shoulder muscles and capsule.

Many patients require an arthroscopic surgical decompression of the subacromial space (space between humeral head and undersurface of the acromion bone) to treat chronic pain associated with this condition. As an alternative to surgery, a specific exercise program has been found to be effective in significantly decreasing shoulder pain arising from impingement. A recent 2012 study in Sweden emphasised the effectiveness of specific physiotherapy intervention in decreasing the need for invasive procedures in patients suffering from impingement-related shoulder pain.

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The study involved 97 patients aged 30-65 who presented to an orthopaedic surgeon with chronic pain stemming from subacromial impingement syndrome. These patients had demonstrated minimal response to a variety of non-invasive conservative treatment over the previous 3 months and had been placed on the waiting list for arthroscopic subacromial depression. The patients were divided into two groups and randomly assigned 1 of 2 exercise programs.

Group 1 was assigned a program specific to shoulder impingement syndrome which was based on the latest clinical research. The 12 week program involved eccentric/concentric movements and stretching aimed at stabilising the scapula and strengthening the rotator cuff. These exercises were progressed at each physio session, utilising weights and elastic rubber bands (e.g. Therabands) to provide additional resistance.

Group 2 acted as the control group and were assigned 6 non-specific strengthening and stretching exercises for the neck and shoulder using no external load. These patients were not progressed for the duration of the program. Both groups carried out their exercises at home either once or twice per day, depending on the exercises prescribed.

 

The success of the treatment was interpreted through the Constant-Murley shoulder assessment score. This outcome measure includes a variety of objective and subjective measurements, such as range of motion, strength, pain, work load and leisure activities. The outcome is measured as a score out of 100, with a higher score indicating increased shoulder function.

The control group improved by an average of 9 points on the Constant-Murley shoulder assessment score, while the group undertaking a specific exercise program improved by an average of 24 points.

At the end of the trial period, only 20% of patients who had been treated with specific physiotherapy intervention chose to undergo surgery, as opposed to 63% in the control group.

A specific, progressive physiotherapy intervention was effective in decreasing the instances of surgery in patients who suffer from subacromial impingement syndrome who had been unresponsive to other forms of intervention.

In this study the positive results of the treatment plan are attributed to the eccentric motion of the prescribed exercises. Eccentric exercises have been effective in treating tendinosis in other parts of the body (e.g. achilles tendinopathy), however the mechanism of treatment is not yet fully understood.

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Reference:

Adolfsson L., Hallgren H B., Holmgrem T., Oberg B. (2012) Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. British Medical Journal 344:e787