Arthroscopic acromioplasty provides no clinically important effects in patients with shoulder impingement syndrome over a structured and supervised exercise program alone in terms of subjective outcome or cost-effectiveness when measured at 24 months, say authors of a study published in the October 2009 issue (Vol 91, Issue 10) of Journal of Bone and Joint Surgery.

140 patients were randomized into 2 treatment groups: a supervised exercise program (exercise group) and arthroscopic acromioplasty followed by a similar exercise program (combined treatment group). The main outcome measure was self-reported pain on a scale of 0 to 10 at 24 months, measured on the 134 patients (66 in the exercise group and 68 in the combined treatment group) for whom endpoint data were available. An intention-to-treat analysis disclosed an improvement in both groups but without statistically significant difference in outcome between the groups.

The combined treatment cost considerably more, the authors say. Structured exercise treatment should be the basis for treatment of shoulder impingement syndrome, with operative treatment offered judiciously until its true merit is proven.