Petersson Anna H, Björnsson Hallgren Hanna C, Adolfsson Lars E, Holmgren Theresa M
Unit of Physiotherapy, Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden.
Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden; Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
J Shoulder Elbow Surg. 2025 Jun;34(6):e477-e487. doi: 10.1016/j.jse.2024.10.027. Epub 2024 Dec 21.
Subacromial pain is a common and disabling condition with multifactorial etiology. Increasing evidence supports exercises as first-line treatment and need of surgery is debated. Long-term follow-ups after surgical- and nonsurgical treatment are scarce. The primary aim of the present study was to investigate the 10-year outcomes after a study comparing specific and nonspecific exercise treatment and the need for surgery. Secondarily we compared patients who had undergone exercise treatment, to those having surgery and explored the importance of rotator cuff status in relation to given treatment and outcomes.
At enrollment 2009-2010, 97 patients with long-standing subacromial pain were on the waiting list for arthroscopic subacromial decompression (ASD). They were randomized to specific exercises focusing on strengthening of the rotator cuff and scapula stabilizers (n = 51) or control: unloaded range of motion exercises (n = 46). ASD was optional during the entire observation time. Eligible patients from either group constitute the present 10-year cohort with nonoperated (n = 42) or operated (n = 41) patients. The primary outcome was shoulder function and pain after 10 years assessed by the Constant-Murley score (CMS). Secondary outcomes were proportion of patients choosing surgery and rotator cuff status related to treatment and primary outcome.
At the 10-year follow-up, 83 of 97 patients (86%) participated. All patients significantly improved in CMS from baseline to 10-year follow-up, mean improvement of 37 (95% confidence interval 33-41, P < .0001). Nonoperated patients had significantly better CMS compared to operated with mean difference 11 (95% confidence interval 4-18) (P = .003). Significantly more patients in the control exercise group 65% (26 of 40) had chosen surgery compared to 35% (15 of 43) in the specific exercise group up until 10 years (P = .006). At 10 years, 55% of the patients had a partial or full-thickness rotator cuff tear compared to 28% at baseline. There was no difference in tear progression between operated and nonoperated patients (P = .494). In the contralateral shoulder, 51% of the patients (39 of 76) had a cuff tear compared to 3% at baseline.
Specific exercise treatment for patients with subacromial pain was effective and reduced the need for surgery with maintained results after 10 years. Responders to exercise treatment had the best long-term outcomes and ASD yielded satisfying outcome in nonresponders. A rotator cuff tear was equally common in patients having undergone surgery as in those treated nonoperatively and in the contralateral shoulder.
肩峰下疼痛是一种常见且致残的疾病，病因多因素。越来越多的证据支持运动作为一线治疗方法，而手术需求存在争议。手术和非手术治疗后的长期随访很少。本研究的主要目的是调查一项比较特定和非特定运动治疗及手术需求的研究后的10年结果。其次，我们比较了接受运动治疗的患者与接受手术的患者，并探讨了肩袖状态与给定治疗和结果的关系。
在2009 - 2010年入组时，97例长期肩峰下疼痛患者在等待关节镜下肩峰下减压（ASD）。他们被随机分为专注于加强肩袖和肩胛骨稳定肌的特定运动组（n = 51）或对照组：无负荷活动范围运动组（n = 46）。在整个观察期内ASD是可选的。来自两组的符合条件的患者构成了目前的10年队列，包括未手术（n = 42）或手术（n = 41）的患者。主要结局是10年后通过Constant - Murley评分（CMS）评估的肩部功能和疼痛。次要结局是选择手术的患者比例以及与治疗和主要结局相关的肩袖状态。
在10年随访时，97例患者中有83例（86%）参与。所有患者的CMS从基线到10年随访均显著改善，平均改善37（95%置信区间33 - 41，P <.0001）。未手术患者相比手术患者CMS显著更好，平均差异为11（95%置信区间4 - 18）（P =.003）。直到10年，对照组运动组中显著更多的患者65%（40例中的26例）选择了手术，而特定运动组为35%（43例中的15例）（P =.006）。在10年时，55%的患者有部分或全层肩袖撕裂，而基线时为28%。手术和未手术患者之间的撕裂进展没有差异（P =.494）。在对侧肩部，51%的患者（76例中的39例）有肩袖撕裂，而基线时为3%。
肩峰下疼痛患者的特定运动治疗有效，减少了手术需求，且10年后仍保持效果。运动治疗的反应者有最佳的长期结局，而ASD在无反应者中产生了令人满意的结果。肩袖撕裂在手术患者和非手术治疗患者以及对侧肩部中同样常见。
