title: Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?
abstract: OBJECTIVE
  Shoulder impingement syndrome is common, but treatment is controversial. Arthroscopic acromioplasty is popular even though its efficacy is unknown. In this study, we analyzed stage-II shoulder impingement patients in subgroups to identify those who would benefit from the operation.
  
  
  METHODS
  In a previous randomized study, 140 patients were either treated with a supervised exercise program or with arthroscopic acromioplasty followed by a similar exercise program. The patients were followed up at 2 and 5 years after randomization. Self-reported pain was used as the primary outcome measure.
  
  
  RESULTS
  Both treatment groups had less pain at 2 and 5 years, and this was similar in both groups. Duration of symptoms, marital status (single), long periods of sick leave, and lack of professional education appeared to increase the risk of persistent pain despite the treatment. Patients with impingement with radiological acromioclavicular (AC) joint degeneration also had more pain. The patients in the exercise group who later wanted operative treatment and had it did not get better after the operation.
  
  
  CONCLUSIONS
  The natural course probably plays a substantial role in the outcome. Based on our findings, it is difficult to recommend arthroscopic acromioplasty for any specific subgroup. Regarding operative treatment, however, a concomitant AC joint resection might be recommended if there are signs of AC joint degeneration. Even more challenging for the development of a treatment algorithm is the finding that patients who do not recover after nonoperative treatment should not be operated either.
authors: a 1 Coxa Hospital for Joint Replacement , Tampere.
authors: Saara
authors: S
authors: Ketola
authors: b 2 Hatanpää Hospital , Tampere.
authors: Janne
authors: J
authors: Lehtinen
authors: c 3 Kanta-Häme Central Hospital , Hämeenlinna.
authors: Timo
authors: T
authors: Rousi
authors: d 4 Helsinki University Central Hospital , Helsinki.
authors: Maunu
authors: M
authors: Nissinen
authors: e 5 University of Tampere , Tampere, Finland.
authors: Heini
authors: H
authors: Huhtala
authors: c 3 Kanta-Häme Central Hospital , Hämeenlinna.
authors: Ilkka
authors: I
authors: Arnala
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019534:Shoulder Impingement Syndrome / Q000601:surgery / Q000628:therapy*; D020069:Shoulder Pain / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult