Article

OBJECTIVE: To investigate the evidence on effectiveness of surgery for shoulder
impingement compared with conservative treatment. DATA SOURCES: Cochrane
Controlled Trials Register, MEDLINE, EMBASE, CINAHL and Science Citation Index
databases were searched in March 2013 unrestricted by date or language. STUDY
SELECTION: Controlled randomized (RCT) or quasi-randomized clinical trials
comparing surgery and conservative treatment of shoulder impingement were
included. DATA EXTRACTION: The methodological quality of each included trial was
assessed according to the Cochrane Collaboration's domain-based evaluation
framework. DATA SYNTHESIS: Of seven included RCTs, risk of systematic bias was
considered to be low for two, high for four, and unclear for one RCT. The
random-effect meta-analysis was conducted on four RCTs involving 347 subjects
(173 surgically treated cases and 174 controls). There was no significant
difference in changes in pain intensity between surgically and conservatively
treated subjects (Hedges's g = 0.01 in favor of conservative treatment, 95% CI
-0.27 to 0.30). CONCLUSION: Based on the review of seven RCTs, the evidence on
effectiveness of surgical or conservative treatment of shoulder impingement was
found to be limited. There was, however, moderate evidence that surgical
treatment is not more effective than active exercises on reducing pain intensity
caused by shoulder impingement. Implications for Rehabilitation Based on the
review of seven RCTs, the evidence on effectiveness of surgical or conservative
treatment of shoulder impingement was found to be limited. There was moderate
evidence that surgical treatment is not more effective than active exercises on
reducing pain intensity caused by shoulder impingement. Because of surgery's
higher costs and susceptibility for complications compared with costs and risks
of conservative treatment, conservative treatment can be recommended as a first
choice of treatment of shoulder impingement in first or second grade.

Langue : ANGLAIS