title: A specific exercise strategy reduced the need for surgery in subacromial pain patients.
abstract: OBJECTIVE
  A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up. The purposes of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score, rotator cuff status and radiological findings influenced the outcome.
  
  
  METHODS
  97 patients on the waiting list for arthroscopic subacromial decompression had been randomised to a specific exercise programme or unspecific exercises (controls). After 3 months of exercises, the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up. 1 year after inclusion or 1 year after surgery, the number of patients who decided to have surgery in each group was compared. The choice of surgery was related to the baseline Constant-Murley score, ultrasound and radiographs taken at inclusion.
  
  
  RESULTS
  All patients had improved significantly (p<0.0001) in the Constant-Murley score at the 1-year follow-up. Significantly more patients in the control group decided to have surgery (63%) than those in the specific exercise group (24%; p<0.0001). Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear. Patients with partial tears did not differ from those with intact tendons.
  
  
  CONCLUSIONS
  The positive short-term results of specific exercises were maintained after 1 year, and this exercise strategy reduces the need for surgery. Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome.
  
  
  BACKGROUND
  Clinical trials NCT01037673.
authors: Department of Orthopeadics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors: Hanna C Björnsson
authors: HC
authors: Hallgren
authors: Division of Physiotherapy, Institution of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors: Theresa
authors: T
authors: Holmgren
authors: Division of Physiotherapy, Institution of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors: Birgitta
authors: B
authors: Oberg
authors: Division of Physiotherapy, Institution of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors: Kajsa
authors: K
authors: Johansson
authors: Department of Orthopeadics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors: Lars E
authors: LE
authors: Adolfsson
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D005081:Exercise Therapy / Q000379:methods; D010349:Patient Compliance; D010358:Patient Participation; D011859:Radiography; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000628:therapy; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging / Q000628:therapy; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome
keywords: Eccentric exercise; Physiotherapy; Shoulder injuries; Tendons; Ultrasound