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European Journal of Physical and Rehabilitation Medicine 2013 August;49(4):499-505

Copyright © 2013 EDIZIONI MINERVA MEDICA

lingua: Inglese

Exercise therapy is evidence-based treatment of shoulder impingement syndrome. Current practice or recommendation only

Ylinen J. 1, Vuorenmaa M. 1, Paloneva J. 2, Kiviranta I. 3, Kautiainen H. 4, 5, Oikari M. 1, Häkkinen A. 1, 6

1 Department of Physical and Rehabilitation Medicine Jyväskylä Central Hospital, Jyväskylä, Finland; 2 Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland; 3 Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; 4 Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland; 5 University of Helsinki, Department of General Practice, Helsinki, Finland; 6 Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland


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Background: Subacromial impingement syndrome is the most common indication for shoulder operation. However, exercise therapy for the conservative treatment is recommended in the first instance.
Aim: To evaluate the implementation of exercise therapy in impingement syndrome.
Design: Retrospective study using structured postal questionnaire and data collected from hospital archive.
Methods: A total of 104 consecutive patients who had undergone shoulder surgery due to impingement syndrome. Patients were asked about therapy modalities that they had received before and after the operation as well as pain (VAS) and functional impairment (ASES) at one-year follow-up.
Results: Before surgery 49% of patients had not received advice for shoulder muscle exercises. After operation all patients had received mobility exercises, but one quarter of patients still reported that they had not received instructions about shoulder strength exercises. At the follow-up the means of the ASES index was 85 and use of NSAID had decreased by 75%. However, 15% of patients had moderate functional impairment (ASES under 60).
Conclusion: About half of patients reported that they had not received advice for rotator cuff exercise therapy before surgery even though with it surgery would probably have been avoided in many cases. Although symptoms in most patients had decreased after operation, several patients still suffered from pain and decreased function. Still several patients had not received advice for shoulder strengthening exercises that are important to recovery.
Clinical Rehabilitation Impact: The adherence to the current recommendations about exercise therapy is insufficient in clinical practice. Thus we recommend that it should be monitored in all institutions in which shoulder pain is treated.

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