| Problem: Orthopedic medical care is constantly evolving, with numerous new forms of treatment. Even with today's treatment modalities, shoulder impingement is increasingly common in the general population. This ailment not only affects quality of life, but if the correct treatment is not initiated in a timely manner, rotator cuff tears can occur presenting a new set of difficulties. Recent studies have demonstrated the effectiveness of these modalities but have not shown what form of treatment is best for a given population. The current debate over surgical versus non-surgical management is how to decide which method will best serve each individual patient, based on the specifics of their case. Methods: Peer reviewed clinical trials and reviews depicting different forms of treatment for subacromial shoulder impingement including surgical, exercise therapy and medical injections were identified using a Pub Med search through the Cornell Medical College library. Results: This search showed that conservative and invasive modalities have lead to successful results. There is firm evidence that both subacromial decompression, acromioplasty and exercise therapy have positive outcomes after 3 months to 2 years post-treatment. Intra-articular injections have also shown short-term benefits. There was no statistically significant indication that one treatment was superior to another. Thus, all forms of treatment are reasonable when managing patients with type I and type II shoulder impingement. Conclusions: With no treatment proving to have an advantage over another, a long term review must compare all combinations of therapy within a very specific demographic in order to have conclusive evidence that can be used in clinical practice. |
