Updated: Aug 24
In the past subacromial decompression surgery became the gold standard intervention to manage 'impingement lesion' in the shoulder (Neer 1983; Judge 2014).
In 2011, however, a narrative review challenged the accepted pathogenesis, diagnosis and management for shoulder impingement. Further, this finding has been repeatedly validated with a number of high-quality reviews and randomised controlled trials reporting no clear benefits of subacromial decompression surgery versus exercise therapy (Lahdeoja et al., 2019) or placebo (Karjalainen et al., 2019; Paavola et al., 2018).
Clinically we also see patients' shoulder symptoms have improved markedly but the 'impingement lesion' remains in situ, casting doubt on the role of surgical management for 'impingement lesion' (Beard et al., 2018).
It is becoming clearer that impingement need not be surgically reduced to appreciably improve a person's pain, function and quality of life.
In fact, recent research has shown the biggest predictors of physiotherapy outcomes for people with shoulder pain are patient's expectations and self-efficacy (Chester et al., 2019; Dunn et al., 2016). Evidence is also starting accumulating suggesting a relationship between rotator cuff-related shoulder pain and metabolic syndrome, which highlights a potential systemic physiological influence in the pathogenesis of SAI (Burne et al., 2019). These findings are unsurprising given what we are now beginning to understand about the role of beliefs, expectations, and lifestyle factors in the pain experience (Tabor et al., 2017; Nijs et al., 2019).