Effectiveness of adding a large dose of shoulder strengthening to current nonoperative care for subacromial impingement

Review written by Dr Teddy Willsey info

Key Points

  1. Recent research has called into question the effectiveness of surgery for subacromial impingement-related shoulder pain, indicating a need for a deeper look at exercise interventions.
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BACKGROUND & OBJECTIVE

In 2020, the British Journal of Sports Medicine (BJSM) published a systematic review strongly discouraging the practice of subacromial decompression surgery, stating that it provided no important benefit compared with placebo surgery or exercise therapy, and carried a small but serious risk (1). While surgery may still be eventually indicated for a specific cohort of patients experiencing subacromial impingement (SI) related shoulder pain, it has become increasingly clear that exercise therapy should be the first line of care.

Shoulder weakness and involvement of the rotator cuff musculotendinous unit is commonly seen alongside SI. Accordingly, shoulder strengthening has been an interventional point of focus. Previous research has failed to differentiate the effectiveness of general versus specific exercise programs or provide a baseline for exercise dosage (2).

The goal of this study was to establish a dose-response relationship for shoulder strengthening exercise and inform clinicians on best practice strategies for the management of SI-related shoulder pain.

Shoulder weakness and involvement of the rotator cuff musculotendinous unit is commonly seen alongside subacromial impingement.
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Simply adding a large dose of monotonous home exercise is not a viable solution to improve patient outcomes.

METHODS

The authors designed a randomized controlled trial, hypothesizing that prescribing a large dose of “add-on” shoulder strengthening home exercises would result in improved outcomes. Both the control group (CG) and intervention group (IG) attended the same standardized physical therapy, termed

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