Rehabilitation in Artroscopic Subacromial Decompression: Five to Six-year Follow-up
GUL BALTACI, İREM DÜZGÜN, VOLGA BAYRAKCI TUNAY
Hacettepe University, School of Physiotherapy and Rehabilitation, Sports Physiotherapy Unit, 06100 Ankara-Turkey. e-mail: ybaltaci@hacettepe.edu.tr

 Purpose: Subacromial impingement syndrome refers to encroachment of the coracoacromial arch on the underlying mechanism of the rotator cuff. Arthroscopic subacromial decompression (ASD) has been shown to be an effective procedure in the treatment of Stage II and early stage III impingement syndrome. The purpose of this study was to investigate the effectiveness of a physiotherapy programme in patients with arthroscopic subacromial decompression.

Materials/Methods: In a clinical randomized prospective study, 33 consecutive patients (34 shoulders) with subacromial impingement resistant to conservative therapy and without full-thickness rotator cuff tears underwent arthroscopic subacromial decompression. Thirty-three patients were available for follow-up, which averaged 46 months (range, 3 to 5 years). There were 15 men and 18 women with a mean age of 41 years (range 18 to 75 years). The average duration of symptoms before treatment was 36 months, ranging from 12 to 100 months. All patients complained of pain and decreased active motion. Postoperative follow-up was performed by an independent observer after 3, 12 and 60 months. All patients received some or all of the following treatment modalities: acromioclavicular joint, thoracic, cervical spine and glenohumeral joint mobilization, exercise therapy including attention to muscle imbalance, postural advice, strapping and, very occasionally, electrotherapy. The outcome instruments used included Neer Shoulder Scoring system, the University of California at Los Angeles (UCLA) Shoulder Rating Scale, Visual Analogue Scale (VAS) for pain, isokinetic dynamometer test results, and range of motion with goniometic measurements 5 to 6 years after surgery. Thirty-three patients were able to complete the study.

Results : We found essentially no differences in the clinical tests after 5 years. No differences were found between the three evaluation years in duration of sick leave and daily intake of analgesics. After six months the difference in improvement in overall Neer score in supervised physiotherapy and rehabilitation was 4.0 (95% confidence interval -2 to 11) after adjustment for ASD. The condition improved significantly compared with after 6, 12 months and 6 years in patients with ASD given the active treatments. When compared with the unaffected extremity, we still find significantly lower results in the operated shoulder after 12 months. A total of 96% received a satisfactory rating with significant improvement in pain, function, motion and strength for ASD even up to 5 years.

Conclusion: We conclude that the choice of rehabilitation program after ASD and 5 to 6 years follow-up after surgery is important to return to work and/or sport activity. Clinical Relevance: Most physical therapists who master in shoulder rehabilitation prefer this type of program.