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Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs

SIS-R: Shoulder Impingement Systematic Review - iStockphoto

Shoulder impingement syndrome (SIS) is a non-specific term and means problem in a structure in the subacromial space (e.g. rotator cuff tendinosis, partial thickness tears of the rotator cuff and bursitis). The aetiology of rotator cuff problems and its relationship to subacromial impingement are still debated.

Most common symptoms of SIS are pain and disability, loss of quality of life and sleep disturbances. Tears in the rotator cuff tendons are common in symptomatic shoulders, but also asymptomatic shoulders (up to 16.9%) can show tears in the rotator cuff. The prevalence increases with age.

We, a team led by Ruedi Steuri (a physiotherapist working in his own private practice and a part time researcher) and Roger Hilfiker, conducted a systematic review and meta-analysis, including 177 randomised studies.

Overall, the found evidence has only very low quality (often small studies, high risk of bias, high heterogeneity). However, we are confident to state that exercise should be considered for all patients with shoulder impingement symptoms, if necessary, tape, shockwave therapy, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise. The side effects of NSAIDS and corticosteroids have to be considered.

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