Wednesday, February 29, 2012 New in the Literature: Subacromial Impingement Syndrome (BMJ 2012 Feb 20 [Epub ahead of print]) A specific exercise strategy that focuses on strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilizers is effective in reducing pain and improving shoulder function in patients with persistent subacromial impingement syndrome, say authors of an article published online in BMJ. By extension, they add, this exercise strategy reduced the need for arthroscopic subacromial decompression within the 3-month timeframe used in the study. This randomized, participant and single assessor blinded controlled study was conducted in an orthopedic department in a Swedish university hospital. Orthopedic specialists recruited 102 patients with longstanding (more than 6 months) persistent subacromial impingement syndrome that did not respond to earlier conservative treatment. The specific exercise strategy consisted of strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilizers in combination with manual mobilization. The control exercise program consisted of unspecific movement exercises for the neck and shoulder. Patients in both groups received 5 to 6 individual guided treatment sessions during 12 weeks. In between these supervised sessions the participants performed home exercises once or twice a day for 12 weeks. The primary outcome was the Constant-Murley shoulder assessment score evaluating shoulder function and pain. Secondary outcomes were patients' global impression of change because of treatment and decision regarding surgery. Most (97, 95%) participants completed the 12-week study. There was a significantly greater improvement in the Constant-Murley score in the specific exercise group than in the control exercise group (24 points vs 9 points). Significantly more patients in the specific exercise group reported successful outcome (defined as large improvement or recovered) in the patients' global assessment of change because of treatment— 69% (35/51) vs 24% (11/46); odds ratio 7.6 (95% confidence interval 3.1 to 18.9). A significantly lower proportion of patients in the specific exercise group subsequently chose to undergo surgery—20% (10/51) vs 63% (29/46); odds ratio 7.7 (95% confidence interval 3.1 to 19.4).