عوامل موثر در پيش آگهي درمان غير جراحي بيماران مبتلا به سندروم ساب آكروميال ايمپينجمنت

Determinants of Non-Surgical Treatment Outcome in Subacromial Impingement Syndrome

Background: Impingement syndrome is one of the numerous causes of shoulder pain. The purpose , of this study is to define the factors that can affect the prognosis of conservative treatment of, subacromial impingement syndrome. Materials and Methods: From July 2001 to 2002, 102 patients with subacromial impingement, being confirmed by clinical tests of impingement, were enrolled in a prospecitve case-series study. They were treated conservatively with corticosteroid injection in subacromial bursa, NSAID administration and physiotherapy, and were followed for 12 months. Any patient with less than 11 months follow-up, with radiographic evidence of glenohumeral and acromioclavicalur arthritis, history of acute traumatic rupture of rotator cuff, proximal fracture of humerous, frozen-shoulder, and diabetes was excluded from the study. The scoring system of Constant and Murley was used for evaluation of treatment outcome. Results: 89 patients (44 male and 45 female) with mean age of 56.4 years completed the study. 67 patients (75.3%) were properly treated. There was a significant difference in Constant scores before and after treatment (p<0.05). A poor prognosis could be anticipated in those with weakness and/or atrophy of rotator cuffʹ muscles, more than 120 days interval between initiation of symptoms and treatment, hooked acromion morphology, Acromio-Humeral Interval of less than 7 mm, moderate to severe restriction in active range of motion, and spur in antero-inferior edge of acromion. Age, gender, hand dominancy, side of involvement and history of previous trauma had no significant effect. Conclusion: Patients with -some defined poor prognostic factors" will fail conservative treatment. It might be better to consider other treatment modalities, even surgery, early on.