Physical therapist-led exercises show equal effectiveness compared with surgery in the long term in patients with shoulder impingement syndrome, say authors of a systematic review published in the October 2009 issue (Vol 41 Issue 11) of the Journal of Rehabilitation Medicine.

Research trials were searched electronically and manually from 1966 to December 2007. Study quality was independently assessed by 2 reviewers using the Physiotherapy Evidence Database (PEDro) scale.

16 studies were included. Many different diagnostic criteria for shoulder impingement syndrome were applied. Physical therapist-led exercises and surgery were equally effective treatments for shoulder impingement syndrome in the long term. Adding manual therapy to exercise programs may have an additional benefit on pain at 3 weeks follow-up.

In general, the authors say, the samples were small and different diagnostic criteria were applied, which makes a firm conclusion difficult. More high-quality trials with longer follow-ups are recommended.