If Possible Treat Without Surgery
The authors chose the title “impingement syndrome,” although internationally the term “subacromial pain syndrome” (SAPS) is regarded as more appropriate, because the anatomy and the pain barely correlate and imply a false causality (1).
In the article, one of the take-home messages is that the one-month prevalence of shoulder pain is between 16% and 30%, but the 30% refers to people older than 30. This means that the prevalence in the population in this study is only 16% (2). The statement that “Surgery is indicated if the symptoms fail to improve after 3 or more months of conservative treatment” is ambiguous and is backed up by only one, outdated, source from 1997. A more correct recommendation would be that surgery within the first 3 months is generally not indicated, and only in a few cases afterwards. The current Dutch guideline that the authors cite elsewhere (3) is clearer in this respect: SAPS should if at all possible be treated without surgery...
- If intensive non-surgical treatment does not bring about improvement and rehabilitation is not possible, bursectomy may be considered.
- No indication exists for operating on an asymptomatic rupture of the rotator cuff or calcific tendinitis.
Even after rupture of the rotator cuff, 90% of patients who have not had surgery have no problems or only negligible problems after 14 years (2). That is no worse than the long term results after surgery (4).
Dr. med. Uwe Popert
|1.||Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH: Impingement syndrome of the shoulder. Dtsch Arztebl Int 2017; 114: 765–76. VOLLTEXT|
|2.||Diercks R, Bron C, Dorrestijn O, et al.: Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the dutch orthopaedic association. Acta Orthop 2014; 85: 314–2 CrossRef MEDLINE PubMed Central|
|3.||Kijima H, Minagawa H, Nishi T, Kikuchi K, Shimada Y: Long-term follow-up of cases of rotator cuff tear treated conservatively. J Shoulder Elbow Surg 2012; 21: 491–4 CrossRef MEDLINE|
|4.||Jaeger M, Berndt T, Rühmann O, Lerch S: Patients with impingement syndrome with and without rotator cuff tears do well 20 years after arthroscopic subacromial decompression. Arthroscopy 2016; 32: 409–15 CrossRef MEDLINE|