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. 2020 Summer;72(3):282-297.
doi: 10.3138/ptc-2018-0111.

Conservative versus Surgical Interventions for Shoulder Impingement: An Overview of Systematic Reviews of Randomized Controlled Trials

Goris Nazari  1   2 , Joy C MacDermid  1   2   3 , Pavlos Bobos  1   2
Affiliations

Conservative versus Surgical Interventions for Shoulder Impingement: An Overview of Systematic Reviews of Randomized Controlled Trials

Goris Nazari et al. Physiother Can. 2020 Summer.

Abstract
in English, French

Purpose: Numerous systematic reviews (SRs) of randomized controlled trials (RCTs) have emerged that investigate the effectiveness of conservative (supervised exercises) versus surgical (arthroscopic subacromial decompression) interventions for patients with shoulder impingement; however, there are disparities in the quality of the evidence synthesized. The purpose of this study was to conduct an overview of SRs of RCTs to critically appraise the evidence and establish the current state of effectiveness of conservative versus surgical interventions on clinical outcomes among patients with shoulder impingement. Method: The MEDLINE, EMBASE, CINAHL, and PubMed electronic databases were searched for January 2008 to September 2018, and we found SRs of RCTs of patients with shoulder impingement, subacromial pain syndrome, or subacromial impingement syndrome who had received conservative versus surgical interventions to improve outcomes. Two authors extracted the data, and two independent review authors assessed the risk of bias and quality. Results: A total of 15 SRs were identified. One was rated as high quality, 7 as moderate quality, 5 as low quality, and 2 as critically low quality. The results were in line with one another, indicating that no differences in outcomes existed between conservative and surgical interventions among patients with shoulder impingement. Conclusion: There were no clinically important or statistically significant differences in outcomes between conservative versus surgical interventions among patients with subacromial impingement syndrome. To enhance clinical outcomes in this patient population, shoulder-specific exercises that aim to improve muscle strength and flexibility must be considered as the first line of conservative treatment.

Objectif : de nombreuses analyses systématiques (AS) de récents essais aléatoires et contrôlés (EAC) portent sur l’efficacité d’une intervention prudente (exercices supervisés) au lieu d’une opération (arthroscopie sous-acromiale) chez les patients ayant une impaction de l’épaule, mais la qualité des données synthétisées est hétérogène. La présente étude visait à faire un survol des AS d’EAC pour procéder à une analyse critique des données probantes et déterminer l’efficacité des interventions prudentes par rapport aux opérations sur la situation clinique des patients ayant une impaction de l’épaule. Méthodologie : les chercheurs ont fouillé les bases de données de MEDLINE, EMBASE, CINAHL et PubMed entre janvier 2008 et septembre 2018 et trouvé des AS d’EAC de patients présentant une impaction de l’épaule, un syndrome d’accrochage sous-acromial ou un syndrome de conflit sous-acromial qui ont subi une intervention prudente ou une opération pour améliorer leur situation clinique. Deux auteurs ont extrait les données, et deux auteurs indépendants ont évalué le risque de biais et la qualité. Résultats : Au total, les chercheurs ont extrait 15 AS. L’une était de haute qualité, sept, de qualité modérée, cinq, de basse qualité, et deux, de qualité dangereusement faible. Les résultats étaient équivalents les uns aux autres, c’est-à-dire que les résultats cliniques des interventions prudentes ne différaient pas de ceux des opérations chez les patients présentant une impaction de l’épaule. Conclusion : les chercheurs n’ont constaté aucune différence importante sur le plan clinique ou statistiquement significative entre les résultats cliniques d’une intervention classique et ceux d’une opération chez les patients présentant un syndrome de conflit sous-acromial. Pour améliorer la situation clinique de cette population de patients, le traitement prudent de première ligne consiste à envisager des exercices de l’épaule pour améliorer la force et la flexibilité.

Keywords: conservative treatment; randomized controlled trials; surgery; systematic review.

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Figures

Figure 1
Figure 1
Flowchart of process to select systematic reviews to be selected in the overview.
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