title: Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome)
abstract: OBJECTIVE
  To compare the effectiveness of arthroscopic surgery, a supervised exercise regimen, and placebo soft laser treatment in patients with rotator cuff disease (stage II impingement syndrome).
  
  
  METHODS
  Randomised clinical trial.
  
  
  METHODS
  Hospital departments of orthopaedics and of physical medicine and rehabilitation.
  
  
  METHODS
  125 patients aged 18-66 who had had rotator cuff disease for at least three months and whose condition was resistant to treatment.
  
  
  METHODS
  Arthroscopic subacromial decompression performed by two experienced surgeons; exercise regimen over three to six months supervised by one experienced physiotherapist; or 12 sessions of detuned soft laser treatment over six weeks.
  
  
  METHODS
  Change in the overall Neer shoulder score (pain during previous week and blinded evaluation of function and range of movement by one clinician) after six months.
  
  
  RESULTS
  No differences were found between the three groups in duration of sick leave and daily intake of analgesics. After six months the difference in improvement in overall Neer score between surgery and supervised exercises was 4.0 (95% confidence interval -2 to 11) and 2.0 (-1.4 to 5.4) after adjustment for sex. The condition improved significantly compared with placebo in both groups given the active treatments. Treatment costs were higher for those given surgery (720 pounds v 390 pounds).
  
  
  CONCLUSIONS
  Surgery or a supervised exercise regimen significantly, and equally, improved rotator cuff disease compared with placebo.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ullevaal University Hospital, Oslo, Norway.
authors.forename: J I
authors.initials: JI
authors.lastname: Brox
authors.forename: P H
authors.initials: PH
authors.lastname: Staff
authors.forename: A E
authors.initials: AE
authors.lastname: Ljunggren
authors.forename: J I
authors.initials: JI
authors.lastname: Brevik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005081:Exercise Therapy / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D053685:Laser Therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000191:economics / Q000534:rehabilitation / Q000601:surgery*; D017006:Rotator Cuff / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000191:economics; D013577:Syndrome; D052256:Tendinopathy / Q000191:economics / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome