Shoulder pain remains one of the top 3 reasons patients seek care from their primary care physician and Physical Therapist. The most common diagnosis causing pain among these patients is subacromial impingement syndrome. Impingement can be found along with rotator cuff tendon pain (tendinopathy) or partial rotator cuff tears on clinical exam and imaging. Impingement is often found in patients with rotator cuff and scapular muscle weakness leading to pain and loss of arm function. Physical Therapy remains the first line of treatment for impingement but surgery has also been utilized to treat this condition. A recent review of the literature compared these two approaches.
Nazari and colleagues compared the available research on the effectiveness of Physical Therapy vs. shoulder surgery for patients with impingement (PLoS One. 2019). Authors included 11 randomized controlled trials including over 900 patients with follow up periods up to 10 years after the interventions were performed. Authors reported no difference in outcomes between Physical Therapy vs. Surgery plus post operative Physical Therapy at short or long term follow up periods. Based on this review of the literature Physical Therapy remains a first line treatment for shoulder pain.