Journal of Shoulder and Elbow Surgery
Volume 8, Issue 2 , Pages 102-111 , March 1999

Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): A prospective, randomized, controlled study in 125 patients with a follow-up

  • Jens Ivar Brox, MD, PhD

      Affiliations

    • Corresponding Author InformationReprint requests: Jens Ivar Brox, MD, PhD, National Centre of Orthopaedics, Trondheimsveien 132, N-0570, Norway.
    • Department of Phys Med Rehab, Ullevaal Univ Hosp Oslo, Norway
    • the Department of Surgery, Lovisenberg Hospital, Norwegian Arm Forces, Joint Medical Services, Research and Data Branch, Research Forum, Ullevaal, University Hosp, Oslo, Norway
    • the Division for Physiotherapy Science, University of Bergen, Bergen, Norway.
    • ,
  • Erling Gjengedal, MD

      Affiliations

    • Department of Phys Med Rehab, Ullevaal Univ Hosp Oslo, Norway
    • the Department of Surgery, Lovisenberg Hospital, Norwegian Arm Forces, Joint Medical Services, Research and Data Branch, Research Forum, Ullevaal, University Hosp, Oslo, Norway
    • the Division for Physiotherapy Science, University of Bergen, Bergen, Norway.
    • ,
  • Gisle Uppheim, MD

      Affiliations

    • Department of Phys Med Rehab, Ullevaal Univ Hosp Oslo, Norway
    • the Department of Surgery, Lovisenberg Hospital, Norwegian Arm Forces, Joint Medical Services, Research and Data Branch, Research Forum, Ullevaal, University Hosp, Oslo, Norway
    • the Division for Physiotherapy Science, University of Bergen, Bergen, Norway.
    • ,
  • Audhild Skagseth Bøhmer, PT

      Affiliations

    • Department of Phys Med Rehab, Ullevaal Univ Hosp Oslo, Norway
    • the Department of Surgery, Lovisenberg Hospital, Norwegian Arm Forces, Joint Medical Services, Research and Data Branch, Research Forum, Ullevaal, University Hosp, Oslo, Norway
    • the Division for Physiotherapy Science, University of Bergen, Bergen, Norway.
    • ,
  • John Ivar Brevik

      Affiliations

    • Department of Phys Med Rehab, Ullevaal Univ Hosp Oslo, Norway
    • the Department of Surgery, Lovisenberg Hospital, Norwegian Arm Forces, Joint Medical Services, Research and Data Branch, Research Forum, Ullevaal, University Hosp, Oslo, Norway
    • the Division for Physiotherapy Science, University of Bergen, Bergen, Norway.
    • ,
  • Anne Elisabeth Ljunggren

      Affiliations

    • Department of Phys Med Rehab, Ullevaal Univ Hosp Oslo, Norway
    • the Department of Surgery, Lovisenberg Hospital, Norwegian Arm Forces, Joint Medical Services, Research and Data Branch, Research Forum, Ullevaal, University Hosp, Oslo, Norway
    • the Division for Physiotherapy Science, University of Bergen, Bergen, Norway.
    • ,
  • Peer H. Staff, MD

      Affiliations

    • Department of Phys Med Rehab, Ullevaal Univ Hosp Oslo, Norway
    • the Department of Surgery, Lovisenberg Hospital, Norwegian Arm Forces, Joint Medical Services, Research and Data Branch, Research Forum, Ullevaal, University Hosp, Oslo, Norway
    • the Division for Physiotherapy Science, University of Bergen, Bergen, Norway.

References 

  1. Albertsson M, Karlsson J, Peterson L, Westlin N. Long-term results after resection of the coracroamial ligament for shoulder impingement in athletes. Scand J Med Sci Sports. 1992;2:84–86
  2. Bjørkenheim J-M, Paavolainen P, Ahovuo J, Slätis P. Surgical repair of the rotator cuff and surrounding tissues. Clin Orthop. 1988;236:148–153
  3. Brox JI, Brevik JI. Prognostic factors in patients with rotator tendinosis (stage II impingement syndrome) of the shoulder. Scand J Prim Health Care. 1995;14:100–105
  4. Brox JI, Brevik JI, Ljunggren AE, Staff PH. Influence of anthropometric and psychological variables, pain and disability on isometric endurance of shoulder abduction in patients with rotator tendinosis of the shoulder. Scand J Rehab Med. 1996;28:193–200
  5. Brox JI, Holm I, Ludvigsen P, Steen H. Pain influence on isokinetic shoulder muscle strength in patients with rotator tendinosis (stage II impingement syndrome). Eur J Phys Med Rehabil. 1995;5:196–199
  6. Brox JI, Staff PH, Ljunggren AE, Brevik JI. Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome). BMJ. 1993;307:899–903
  7. Bøhmer AS. Trening ved kroniske degenerative skulderlidelser. Fysioterapeuten. 1984;51:192–197
  8. Bøhmer AS, Brox JI, Staff PH. Supervised exercises in relation to rotator cuff disease (impingement syndrome stage II and II) - a treatment regimen and its rationale. Physical Theory and Practice. 1988;14:93–105
  9. Cyriax J. In: 3rd ed.. Textbook of orthopaedic medicine. Vol 1:London: Bailliere Tindall; 1982;
  10. Derogatis LR, Lipman RS, Rickels K, Uhlenhut EH, Cori L. The Hopkins symptom checklist (HSCL). Behav Sci. 1974;19:1–15
  11. Devor M. What's in a laser beam for pain therapy?. Pain. 1990;43:139
  12. Edelson JG, Taitz C. Anatomy of the coraco-acromial arch. J Bone Joint Surg Br. 1992;74-B:589–594
  13. Ellman H. Arthroscopic subacromial decompression: analysis of one-to three-year results. Arthroscopy. 1987;3:173–181
  14. Frieman BG, Fenlin JM. Anterior acromioplasty: effect of litigation and workers' compensation. J Shoulder Elbow Surg. 1995;4:175–181
  15. Fu FH, Harner C, Klein H. Shoulder impingement syndrome. Clin Orthop. 1991;269:162–173
  16. Hardy D, Vogler J, White R. The shoulder impingement syndrome: prevalence of radiographic findings and correlation with response to therapy. J Radiol. 1986;147:557–561
  17. Holm I, Brox JI, Ludvigsen P, Steen H. External rotation: best isokinetic movement pattern for evaluation of muscle function in rotator tendinosis. A prospective study with a 2-year follow-up. Isokin Exerc Sci. 1996;5:121–125
  18. Järvholm U, Palmerud G, Herberts P, Högfors C, Kadefors R. Intramuscular pressure and electromyography in the supraspinatus muscle at shoulder abduction. Clin Orthop. 1989;245:102–109
  19. Kessel L, Watson M. The painful arch syndrome. A clinical classification as a guide to management. J Bone Joint Surg Br. 1977;59B:166–172
  20. Konttinen YT, Santavita S, Paavolainen P, Antti-Poika I, Tiainen T, Nordstrøm DF, et al.  Immunoreactive neuropeptide nerves in ligamentous tissue in chronic shoulder pain. Arch Orthop Trauma Surg. 1992;111:341–344
  21. Lirette RMF, Kinnard P. The difficulties in assessment of results of anterior acromioplasty. Clin Orthop. 1992;278:14–16
  22. Neer CS. Anterior acromionplasty for the chronic impingement syndrome in the shoulder. J Bone Joint Surg Am. 1972;54A:41–50
  23. Neer CS. Displaced proximal humeral fractures. J Bone Joint Surg Am. 1970;52A:1090–1103
  24. Neer CS. Impingement lesions. Clin Orthop. 1983;173:71–77
  25. Nirschl RP. Rotator cuff tendinitis. Instruct Course Lect. 1987;38:439–445
  26. Nykänen M. Pulsed ultrasound treatment of the painful shoulder: a randomised, double-blind, placebo-controlled study. Scand J Rehabil Med. 1995;27:105–108
  27. Olsson O. Degenerative changes of the shoulder joint and their connection with shoulder pain. In: 3rd ed.. Dissertation. Göteborg: University of Göteborg; 1953;
  28. Ozaki J, Fujimoto S, Nakagawa Y, Masuhara K, Tamai S. Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. J Bone Joint Surg Am. 1988;70A:1224–1230
  29. Paulos LE, Franklin JL. Arthroscopic shoulder decompression: development and application. A five year experience. Am J Sports Med. 1990;18:235–244
  30. Rahme H, Nordgren H, Hamberg H, Wessterberg C-E. The subacromial bursa in the impingement syndrome. A clinical and histological study of 30 cases. Acta Orthop Scand. 1993;63:485–488
  31. Rahme H. Subacromial shoulder pain. Pathogenesis and predictors of surgical outcome. In: 3rd ed.. Dissertation. Uppsala: Faculty of Medicine, University of Uppsala; 1994;
  32. Riley G, Harral RL, Constant CR, Chard MD, Cawston TE, Hazleman BL. Tendon degeneration and chronic shoulder pain: changes in the collagen compostion of the human rotator cuff tendons in rotator cuff tendinitis. Ann Rheum Dis. 1994;53:359–366
  33. Sahlstrand T. Operations for impingement of the shoulder. Early results in 52 patients. Acta Orthop Scand. 1989;60:45–48
  34. Santavirta S, Konttinen YT, Antti-Poika I, Nordstrøm D. Inflammation of the subacromial bursa in chronic shoulder pain. Arch Orthop Trauma Surg. 1992;111:336–340
  35. Soifer TB, Levy HJ, Soifer FM, Kleinbart F, Vigorita V, Bryk E. Neurohistology of the subacromial space. Arthroscopy. 1996;12:182–186
  36. Solem BE, Thuomas K-Å, Westerberg C-E. The influence of scapular retraction and protraction on the width of the subacromial space. Clin Orthop. 1993;296:99–103
  37. Tipton CM, Matthes RD, Maynard JA, Carey RA. The influence of physical activity on ligaments and tendons. Med Sci Sports Exerc. 1975;7:165–175
  38. van der Heijden GJMG, van der Windt DAWM, Kleijnen J, Koes BW, Bouter LM, Knipschild PG. Steroid injections for shoulder disorders. A systematic review of randomized clinical trials. Br J Gen Pract. 1993;43:73–77
  39. Vangsness CT, Ennis M, Taylore JG, Atkinson R. Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy. 1995;11:180–184
  40. Winters JC, Sobel JS, Groenier KH, Arendzen HJ, Meyboomde Jong B. Comparison of physiotherapy, manipulation and corticosteroid injection for treating shoulder complaints in general practice: randomized, single blind study. BMJ. 1997;314:1320–1325
  41. Woo SLY, Gomez MA, Woo YK, Akeson WH. Mechanical properties of tendon and ligaments. Biorheology. 1982;19:397–408
  42. Wuelker N, Roetman B, Roessig S. Coracoacromial pressure recordings in a cadaveric model. J Shoulder Elbow Surg. 1995;4:462–467

☆ Supported by grants from the Norwegian Research Council.

PII: S1058-2746(99)90001-0

Journal of Shoulder and Elbow Surgery
Volume 8, Issue 2 , Pages 102-111 , March 1999

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