Subacromial impingement steroid injection

You will be seen back in the office within a day or two of your surgical procedure.  At that time the dressing will be removed and the incisions will be covered with "band-aids".  You will be given a prescription to start physical therapy.  As in the non-operative management of subacromial impingement syndrome, physical therapy is the mainstay of treatment to achieve as complete a recovery as possible.  Patients should not be discouraged if the pre-operative pain does not improve right away.  The symptoms may take up to three months to resolve, at which time the full benefits of surgery are noted.  However, the majority of patients see a dramatic and rapid improvement of their symptoms soon after surgery.

Study Design Single-blind randomized trial. Background Extracorporeal shockwave therapy (ESWT) has been shown to produce good results in the treatment of subacromial impingement syndrome (SAIS). The efficacy of a combined administration of ESWT and isokinetic exercise (IE) has not yet been studied. Objectives To evaluate the efficacy of focused ESWT combined with IE for the rotator cuff versus focused ESWT alone in the treatment of SAIS. The secondary objective was to assess the isokinetic torque recovery (external rotation at 210°/s, 180°/s, and 120°/s). Methods Thirty participants with SAIS were randomly assigned to a focused-ESWT group or focused ESWT-plus-IE group. Subjects of both groups received 3 treatment sessions of focused ESWT over a period of 10 days. Participants in the second group also received IE for 10 therapy sessions. Outcome measures were the Constant-Murley score (CMS), the visual analog scale (VAS), and isokinetic parameters (peak torque and total work calculated from 5 repetitions) measured with the isokinetic test. Subjects were assessed at baseline, 10 days after the last treatment session with focused ESWT, and after 2 months of follow-up. Results At 2 months posttreatment, participants in the focused ESWT-plus-IE group showed significantly less pain (focused-ESWT VAS, ± versus focused ESWT-plus-IE VAS, ± ; P<.001) and greater improvement in functionality (focused-ESWT CMS, ± versus focused ESWT-plus-IE CMS, ± ; P<.001) and muscle endurance than the subjects in the focused-ESWT group. Conclusion In subjects with SAIS, combined administration of focused ESWT and IE for the rotator cuff resulted in greater reduction of pain, as well as superior functional recovery and muscle endurance in the short to medium term, compared with ESWT alone. Level of evidence Therapy, 2b.

Regarding diagnosis:

  • Does individual have any risk factors or predisposing conditions such as work or sports that stress the shoulder, bone spurs, osteoarthritis, shoulder injuries, or degenerative disease?
  • Did the shoulder pain appear suddenly (suggests another diagnosis) or was the onset gradual and progressive (suggests impingement)?
  • Was there pain following an injury?
  • What symptoms does individual have?
  • What were the findings on physical exam?
  • Has individual undergone shoulder x-rays, MRI, ultrasound, or arthrography to establish the diagnosis?
  • Have conditions with similar symptoms been ruled out?
Regarding treatment:
  • Has individual responded favorably to conservative treatment?
  • Did individual undergo shoulder manipulation under anesthesia for complicating adhesive capsulitis? Was surgery performed? What type? Were there complications from surgery?
Regarding prognosis:
  • Is recovery prolonged due to surgery?
  • Is individual active in physical therapy? In a home exercise program?
  • Is individual's employer able to accommodate the necessary restrictions?
  • Does individual have osteoarthritis, rheumatoid arthritis, shoulder injuries, shoulder instability, or shoulder degeneration?
  • Does individual have complications such as rotator cuff tear, biceps tendinitis, bursitis, or frozen shoulder?
  • Is the affected shoulder on the individual’s dominant or nondominant side?
Source: Medical Disability Advisor

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  • Citation tools Download this article to citation manager Holmgren Theresa , Björnsson Hallgren Hanna , Öberg Birgitta , Adolfsson Lars , Johansson Kajsa . Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study BMJ 2012; 344 :e787
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  • Subacromial impingement steroid injection

    subacromial impingement steroid injection

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  • Citation tools Download this article to citation manager Holmgren Theresa , Björnsson Hallgren Hanna , Öberg Birgitta , Adolfsson Lars , Johansson Kajsa . Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study BMJ 2012; 344 :e787
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