Guided subacromial injection and Physiotherapy versus Arthroscopic Acromioplasty for Treatment of Shoulder Impingement

In a randomized trial we have compared the results of C-arm guided subacromial injection of corticosteroids and local anesthetics and those of arthroscopic bursal Debridment and acromioplasty in sixty patients (seventy two shoulders) aged between 26-58 years, with shoulder pain and positive signs of bursitis and impingment of at least three months duration. Group A (who received local guided injection and physiotherapy) included 40 shoulders, whereas Group B (who had an arthroscopy procedure) included 32 patients. Details of evaluation using Neer and Hawkins impingment signs were analyzed before and after both procedures. Pain was assessed using a subjective pain score, analysis of the final range of motion as well as strength were also reported. At a mean follow up period of eight months results for both groups were compared. The overall percentage of improvement in both groups were 64.3% in group A, versus 72.2% in group B. Group B however showed faster recovery and return to work and recreational activities. Clear criteria for selection of treatment option still need to be defined.