Evidence-based recommendations for the treatment of mechanical outlet impingement
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Übersicht Obere Extremität https://doi.org/10.1007/s11678-020-00579-9 Received: 13 December 2019 Accepted: 14 May 2020 © The Author(s) 2020
Sophia M. Hünnebeck1
· Maurice Balke2,3 · Ralf Müller-Rath4 · Markus Scheibel5,6
1
Abteilung für Obere Extremität, Hand- und Mikrochirurgie, Immanuel Krankenhaus Berlin, Berlin, Germany 2 Sportsclinic Cologne, Cologne, Germany 3 Universität Witten/Herdecke, Witten, Germany 4 OPND, Neuss, Germany 5 Schulthess Klinik, Zurich, Switzerland 6 Charité Universitätsmedizin Berlin, Berlin, Germany
Evidence-based recommendations for the treatment of mechanical outlet impingement Introduction The relative benefits of the various therapeutic options for the treatment of impingement syndrome of the shoulder joint are a topic of ongoing debate. The main problem concerning almost all published studies is that they are based on a mixture of pathologies and the inclusion criteria are not homogenous. Several unspecific studies merge the pathology of subacromial impingement syndrome with subacromial pain syndrome, and do not differentiate the outcomes according to the different pathologies. A small number of randomized controlled trials (RCTs) are more thorough and are therefore a focus of interest. These trials, and a number of review articles, question the indication for surgery in patients with subacromial impingement syndrome. It is therefore of great importance to elucidate the correct and appropriate pathway for the treatment of these patients. This article discusses several randomized trials studying the outcomes of surgical subacromial decompression compared to conservative therapy or sham surgery. The authors included prospective randomized trials, systematic reviews and meta-analyses listed in Pubmed in the last 30 years that compared either surgical and/or conservative treatment to other treatment options of subacromial impingement/ subacromial pain syndrome. In total,
12 studies were included in the detailed analysis (shown in . Table 1).
Aetiology and terminology The terms used to describe shoulder-associated pathologies are, in themselves, a matter of ongoing debate: for example, the use of subacromial impingement syndrome (SIS) or subacromial pain syndrome (SAPS) as opposed to mechanical outlet impingement (MOI) or mechanical non-outlet impingement (MNOI) [7, 11]. The pathology of SIS has been established since the 1970s and describes entrapment of the supraspinatus tendon, the subacromial bursa or the long head of biceps tendon between the humeral head and coracoacromial bone. SIS therefore includes functional pathologies of the soft tissue [5, 18, 28]. In order to respect the content of all terminologies, and to refer to possibly different reasons for subacromial impingement, the name subacromial pain syndrome was later introduced [7]. This definition was initially published in Dutch guidelines for the diagnosis and therapy of SAPS and summarizes atraumatic, mostly unilateral pathologies that lead to shoulder pain that increases during abduction of the joint. Subsequently, SAPS ha
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