Subacromial Impingement Syndrome
Conditions
Keywords
Subacromial impingement, Shoulder, RCT, Effectiveness, Cost-effectiveness
Brief summary
The study aims at determining the effectiveness and cost-effectiveness of surgical management of subacromial impingement (including partial tears) compared to conservative treatment. The research setting is prospective, randomised, and controlled. The aim of the study is to search out evidence based data of indications for subacromial decompression. The investigators also aim at offering patients the most efficient and effective treatment and reduce the number of operations that do not have sufficient effectiveness. The data obtained will facilitate developing guidelines for referrals to a specialist when subacromial impingement is suspected. The investigators hypothesise that there are subgroups of patients suffering from subacromial impingement that benefit from surgery whereas other subgroups are best treated conservatively.
Detailed description
Subgroup analysis: * age * sex * duration of symptoms * presence of trauma before symptoms * presence of partial tear * degenerative findings * other findings in MRI or arthroscopy * type of operation * co-morbidities * occupation * pain (VAS) * objective shoulder function * activities of daily living
Interventions
PROCEDUREAcromioplasty
Arthroscopic or open acromioplasty
PROCEDUREPhysiotherapy
Physiotherapy according to a standardized protocol
Sponsors
Academy of Finland
Oulu University Hospital
Central Finland Hospital District
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
35 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age over 35 years old * duration of symptoms at least three months despite non-operative treatment * accepts both treatment options (operative and physical therapy) * must have pain in abduction of the shoulder * must have painful arc * must have pain in two of the three isometric tests (0 and 30 degrees of abduction, or external rotation) * a positive result in the impingement test (a subacromial injection of lidocaine reduces pain)
Exclusion criteria
* previous shoulder operations * too high risk for operation * any disease or social problem reducing the ability to co-operate * rheumatoid arthritis * severe arthrosis of the glenohumeral or acromioclavicular joint * a full-thickness rotator cuff tear in MRI arthrography * a progressive malign disease * adhesive capsulitis * high-energy trauma before symptoms * cervical syndrome * shoulder instability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in pain (VAS) and objective shoulder function (Constant score) | 24 months after intervention | VAS (0 to 100 mm), Constant score (0 to 100 points) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in pain (VAS) and objective shoulder function (Constant score) | 3 months after intervention | VAS (0 to 100 mm), Constant score (0 to 100 points) |
Countries
Finland
Outcome results
None listed