DÄ internationalArchive19/2018If Possible Treat Without Surgery
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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symptoms fail to improve after 3 or more months of conservative treatment” is ambiguous and is backed up by only one, outdated, source from 1997.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).

DOI: 10.3238/arztebl.2018.0342a

Dr. med. Uwe Popert
Kassel

uwe.popert@web.de

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
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

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