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Patients who are candidates for subacromial decompression have more pronounced range of motion deficits, but do not differ in self-reported shoulder function, strength or pain compared to non-candidates

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Subacromial impingement syndrome (SIS) is associated with low self-reported shoulder function, impairments in shoulder strength and range of motion (ROM), and pain. It is not known how the symptomatology associated with SIS is reflected in the choice of treatment. This study compares self-reported shoulder function, shoulder strength, ROM, and pain in patients with SIS considered candidates and non-candidates for subacromial decompression (SAD).

Method

Self-reported shoulder function (Q-DASH and SPADI), maximum isometric muscle strength in shoulder abduction (Abd-strength) and external rotation (ER-strength), active abduction ROM (Abd-ROM) and passive internal rotation ROM (IR-ROM) were measured in a consecutive cohort of patients with SIS referred to an orthopedic outpatient clinic. Additionally, pain during each test and pain levels during the last week were reported. Patients were categorized as candidates or non-candidates for SAD based on their consultation with an orthopedic specialist blinded to test results and self-reported shoulder function. All outcomes and age, gender, weight and duration of symptoms were compared using the unpaired t test or Mann–Whitney’s U test as appropriate.

Results

One-hundred and fifty-seven patients were included. 25 patients were candidates for SAD, while 132 were not. SAD candidates had significantly lower Abd-ROM (87° vs. 112°, p = 0.011, effect size = 0. 15) and IR-ROM (114° vs. 123°, p = 0.026, effect size = 0.58) additional to higher pain during test of Abd-strength (5.3 vs. 3.7, p = 0.02, effect size = 0.21). No other differences were found between the groups.

Conclusion

A decrease in abduction and internal rotation range of motion, and increased pain during maximal abduction strength effort are associated with being considered a candidate for subacromial decompression, while self-reported shoulder function, pain during the last week, and rotator cuff strength are not. As SAD candidates primarily differentiates from non-candidates by having more pronounced ROM deficits, it might be important to address ROM in pre- and postsurgical evaluations, but as the overall differences between the two groups seem minor, the relation between impairments and the choice of treatment needs further clarification.

Level of evidence

IV.

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Abbreviations

SIS:

Subacromial impingement syndrome

ROM:

Range of motion

SAD:

Subacromial decompression

Q-DASH:

Quick version of the disabilities of the arm, shoulder and hand outcome measure

SPADI:

Shoulder pain and disability index

Abd-strength:

Maximum isometric muscle strength in shoulder abduction

ER-strength:

Maximum isometric muscle strength in shoulder external rotation

Abd-ROM:

Active abduction range of motion

IR-ROM:

Passive internal rotation range of motion

NPRS:

Numeric pain rating scale

CI:

Confidence interval

Abd-ROMPain :

Pain during test of Abd-ROM

NPRS-Max/-Min/-Avg:

Maximum/minimum/average shoulder pain during the last week

NPRS-Pre:

Present shoulder pain.

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Acknowledgements

The authors would like to thank Peter Andreas Rothe, Jens Langermann and Kika Holm for assisting with the data collection.

Funding

The study was funded by University College Copenhagen; Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark.

Author information

Authors and Affiliations

  1. Sports Orthopedic Research Center - Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager & Hvidovre, Denmark

    Adam Witten, Mikkel B. Clausen, Kristian Thorborg, Mikkel L. Attrup & Per Hölmich

  2. Department of Physiotherapy and Occupational Therapy, University College Copenhagen, Copenhagen, Denmark

    Mikkel B. Clausen

Authors
  1. Adam Witten
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  2. Mikkel B. Clausen
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  3. Kristian Thorborg
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  4. Mikkel L. Attrup
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  5. Per Hölmich
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Contributions

AW contributed to the design of the study, and acquisition, analysis and interpretation of data. MBC contributed with the acquisition and interpretation of data. MLA contributed with the acquisition of data. KT and PH contributed to the design of the study and interpretation of data. All authors have contributed to the manuscript and approved the final version.

Corresponding author

Correspondence to Adam Witten.

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Conflict of interest

The authors declare to have no financial or non-financial competing interests.

Ethical approval

The project was approved by the Danish Data Protection Agency, and has also been evaluated by the Capitol Region Committee on Health Research Ethics in Denmark, where it was evaluated as not requiring formal ethical approval (H-3-2013-FSP29).

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Witten, A., Clausen, M.B., Thorborg, K. et al. Patients who are candidates for subacromial decompression have more pronounced range of motion deficits, but do not differ in self-reported shoulder function, strength or pain compared to non-candidates. Knee Surg Sports Traumatol Arthrosc 26, 2505–2511 (2018). https://doi.org/10.1007/s00167-018-4894-6

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