Meta-analysis| Volume 38, ISSUE 8, P2511-2524, August 2022

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Physical Therapy Combined With Subacromial Cortisone Injection Is a First-Line Treatment Whereas Acromioplasty With Physical Therapy Is Best if Nonoperative Interventions Fail for the Management of Subacromial Impingement: A Systematic Review and Network Meta-Analysis

Published:February 18, 2022DOI:


      To construct an algorithm to optimize clinical outcomes in subacromial impingement based on current, high-level evidence.


      A systematic review of all clinical trials on subacromial impingement published from 1999 to 2020 was performed. Demographic, clinical, range of motion (ROM), and patient-reported outcome measure (PROM) data were collected. Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects model and treatments ranked via surface under the cumulative ranking curves with respect to 3 domains: pain, PROMs, and ROM.


      A total of 35 studies comprising 3,643 shoulders (42% female, age 50 ± 5 years) were included. Arthroscopic decompression with acromioplasty ranked much greater than arthroscopic decompression alone for pain relief and PROM improvement, but the difference in absolute PROMs was not statistically significant. Corticosteroid injection (CSI) alone demonstrated inferior outcomes across all 3 domains (pain, PROMs, and ROM) with low cumulative rankings. Physical therapy (PT) with CSI demonstrated moderate-to-excellent clinical improvement across all 3 domains whereas PT alone demonstrated excellent ROM and low-moderate outcomes in pain and PROM domains. PT with nonsteroidal anti-inflammatory drugs or alternative therapies ranked highly for PROM outcomes and moderate for pain and ROM domains. Finally, platelet-rich plasma injections demonstrated moderate outcomes for pain, forward flexion, and abduction with very low-ranking outcomes for PROMs and external rotation.


      Arthroscopic decompression with acromioplasty and PT demonstrated superior outcomes whereas CSI demonstrated poor outcomes in all 3 domains (pain, PROMs, and ROM). For patients with significant symptoms, the authors recommend PT with CSI as a first-line treatment, followed by acromioplasty and PT if conservative treatment fails. For patients with symptoms limited to 1 to 2 domains, the authors recommend a shared decision-making approach focusing on treatment rankings within domains pertinent to individual patient symptomatology.

      Level of Evidence

      I, systematic review and network meta-analysis of Level I studies.
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        • Patel R.M.
        • Gelber J.D.
        • Schickendantz M.S.
        The weight-bearing shoulder.
        J Am Acad Orthop Surg. 2018; 26: 3-13
        • Juel N.G.
        • Natvig B.
        Shoulder diagnoses in secondary care, a one year cohort.
        BMC Musculoskelet Disord. 2014; 15: 89
        • Soslowsky L.J.
        • Thomopoulos S.
        • Esmail A.
        • et al.
        Rotator cuff tendinosis in an animal model: Role of extrinsic and overuse factors.
        Ann Biomed Eng. 2002; 30: 1057-1063
        • Leong H.
        • Fu S.
        • He X.
        • Oh J.
        • Yamamoto N.
        • Yung S.
        Risk factors for rotator cuff tendinopathy: A systematic review and meta-analysis.
        J Rehabil Med. 2019; 51: 627-637
        • Michener L.A.
        • Mcclure P.W.
        • Karduna A.R.
        Anatomical and biomechanical mechanisms of subacromial impingement syndrome.
        Clin Biomech. 2003; 18: 369-379
        • Holmgren T.
        • Bjornsson Hallgren H.
        • Oberg B.
        • Adolfsson L.
        • Johansson K.
        Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: Randomised controlled study.
        BMJ. 2012; 344: e787
        • Pieters L.
        • Lewis J.
        • Kuppens K.
        • et al.
        An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain.
        J Orthop Sports Phys Ther. 2020; 50: 131-141
        • Karjalainen T.V.
        • Jain N.B.
        • Page C.M.
        • et al.
        Subacromial decompression surgery for rotator cuff disease.
        Cochrane Database Syst Rev. 2019; 1Cd005619
        • An V.V.G.
        • Farey J.E.
        • Karunaratne S.
        • Smithers C.J.
        • Petchell J.F.
        Subacromial analgesia via continuous infusion catheter vs. placebo following arthroscopic shoulder surgery: A systematic review and meta-analysis of randomized trials.
        J Shoulder Elbow Surg. 2020; 29: 471-482
        • Nazari G.
        • Macdermid J.C.
        • Bryant D.
        • Athwal G.S.
        The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome. A systematic review and meta-analysis.
        PLoS One. 2019; 14e0216961
        • Saltychev M.
        • Aarimaa V.
        • Virolainen P.
        • Laimi K.
        Conservative treatment or surgery for shoulder impingement: Systematic review and meta-analysis.
        Disabil Rehabil. 2015; 37: 1-8
        • Toliopoulos P.
        • Desmeules F.
        • Boudreault J.
        • et al.
        Efficacy of surgery for rotator cuff tendinopathy: A systematic review.
        Clin Rheumatol. 2014; 33: 1373-1383
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        Ann Intern Med. 2009; 151: 264-269
        • Hutton B.
        • Salanti G.
        • Caldwell D.M.
        • et al.
        The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations.
        Ann Intern Med. 2015; 162: 777-784
        • Ertan S.
        • Ayhan E.
        • Güven M.F.
        • Kesmezacar H.
        • Akgün K.
        • Babacan M.
        Medium-term natural history of subacromial impingement syndrome.
        J Shoulder Elbow Surg. 2015; 24: 1512-1518
        • Higgins J.
        • Sterne J.
        • Savovic J.
        • et al.
        Assessing risk of bias in a randomized trial.
        in: 1 ed. Cochrane handbook for systematic reviews of interventions. 6. John Wiley & Sons, Chichester (UK)2020
        • Cohen W.R.
        • Ommani S.
        • Hassan S.
        • et al.
        Accuracy and reliability of fetal heart rate monitoring using maternal abdominal surface electrodes.
        Acta Obstet Gynecol Scand. 2012; 91: 1306-1313
        • Song F.
        • Altman D.G.
        • Glenny A.M.
        • Deeks J.J.
        Validity of indirect comparison for estimating efficacy of competing interventions: Empirical evidence from published meta-analyses.
        BMJ. 2003; 326: 472
        • Marcheggiani Muccioli G.M.
        • Wykes P.
        • Hundle B.
        • Grassi A.
        • Roatti G.
        • Funk L.
        Effects of a synovial fluid substitute on early recovery after arthroscopic subacromial decompression of the shoulder.
        Musculoskelet Surg. 2015; 99: 121-126
        • Lee J.H.
        • Lee S.-H.
        • Song S.H.
        Clinical effectiveness of botulinum toxin type B in the treatment of subacromial bursitis or shoulder impingement syndrome.
        Clin J Pain. 2011; 27: 523-528
        • Karthikeyan S.
        • Kwong H.T.
        • Upadhyay P.K.
        • Parsons N.
        • Drew S.J.
        • Griffin D.
        A double-blind randomised controlled study comparing subacromial injection of tenoxicam or methylprednisolone in patients with subacromial impingement.
        J Bone Joint Surg Br. 2010; 92: 77-82
        • Kim Y.S.
        • Park J.Y.
        • Lee C.S.
        • Lee S.J.
        Does hyaluronate injection work in shoulder disease in early stage? A multicenter, randomized, single blind and open comparative clinical study.
        J Shoulder Elbow Surg. 2012; 21: 722-727
        • Santamato A.
        • Panza F.
        • Notarnicola A.
        • et al.
        Is extracorporeal shockwave therapy combined with isokinetic exercise more effective than extracorporeal shockwave therapy alone for subacromial impingement syndrome? A randomized clinical trial.
        J Orthop Sports Phys Ther. 2016; 46: 714-725
        • Barra López M.E.
        • López de Celis C.
        • Fernández Jentsch G.
        • Raya de Cárdenas L.
        • Lucha López M.O.
        • Tricás Moreno J.M.
        Effectiveness of diacutaneous fibrolysis for the treatment of subacromial impingement syndrome: A randomised controlled trial.
        Man Ther. 2013; 18: 418-424
        • Yilmaz Kaysin M.
        • Akpinar P.
        • Aktas I.
        • et al.
        Effectiveness of shortwave diathermy for subacromial impingement syndrome and value of night pain for patient selection: A double-blinded, randomized, placebo-controlled trial.
        Am J Phys Med Rehabil. 2018; 97: 178-186
        • Yavuz F.
        • Duman I.
        • Taskaynatan M.A.
        • Tan A.K.
        Low-level laser therapy versus ultrasound therapy in the treatment of subacromial impingement syndrome: A randomized clinical trial.
        J Back Musculoskelet Rehabil. 2014; 27: 315-320
        • Subaşi V.
        • Toktaş H.
        • Demirdal U.S.
        • Türel A.
        • Çakir T.
        • Kavuncu V.
        Water-based versus land-based exercise program for the management of shoulder impingement syndrome.
        Turk Fiz Tip Rehab Derg. 2012; 58: 79-84
        • Radnovich R.
        • Trudeau J.
        • Gammaitoni A.R.
        Arandomized clinical study of the heated lidocaine/tetracaine patch versus subacromial corticosteroid injection for the treatment of pain associated with shoulder impingement syndrome.
        J. Pain Res. 2014; 7: 727-735
        • Perez-Merino L.
        • Casajuana M.C.
        • Bernal G.
        • et al.
        Evaluation of the effectiveness of three physiotherapeutic treatments for subacromial impingement syndrome: A randomised clinical trial.
        Physiotherapy. 2016; 102: 57-63
        • Jensen M.P.
        • Trudeau J.J.
        • Radnovich R.
        • Galer B.S.
        • Gammaitoni A.R.
        The pain quality response profile of a corticosteroid injections and heated lidocaine/tetracaine patch in the treatment of shoulder impingement syndrome.
        Clin J Pain. 2015; 31: 342-348
        • Garcia I.
        • Lobo C.
        • Lopez E.
        • Servan J.L.
        • Tenias J.M.
        Comparative effectiveness of ultrasonophoresis and iontophoresis in impingement syndrome: A double-blind, randomized, placebo controlled trial.
        Clin Rehabil. 2016; 30: 347-358
        • Camargo P.R.
        • Haik M.N.
        • Ludewig P.M.
        • Filho R.B.
        • Mattiello-Rosa S.M.
        • Salvini T.F.
        Effects of strengthening and stretching exercises applied during working hours on pain and physical impairment in workers with subacromial impingement syndrome.
        Physiother Theory Pract. 2009; 25: 463-475
        • Akyol Y.
        • Ulus Y.
        • Durmus D.
        • et al.
        Effectiveness of microwave diathermy on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome: A randomized placebo-controlled clinical study.
        Rheumatol Int. 2012; 32: 3007-3016
        • Okmen B.M.
        • Okmen K.
        Comparison of photobiomodulation therapy and suprascapular nerve-pulsed radiofrequency in chronic shoulder pain: A randomized controlled, single-blind, clinical trial.
        Lasers Med Sci. 2017; 32: 1719-1726
        • Bal A.
        • Eksioglu E.
        • Gurcay E.
        • Gulec B.
        • Karaahmet O.
        • Cakci A.
        Low-level laser therapy in subacromial impingement syndrome.
        Photomed Laser Surg. 2009; 27: 31-36
        • Gunay Ucurum S.
        • Kaya D.O.
        • Kayali Y.
        • Askin A.
        • Tekindal M.A.
        Comparison of different electrotherapy methods and exercise therapy in shoulder impingement syndrome: A prospective randomized controlled trial.
        Acta Orthop Traumatol Turc. 2018; 52: 249-255
        • Gomes C.
        • Dibai-Filho A.V.
        • Moreira W.A.
        • Rivas S.Q.
        • Silva E.D.S.
        • Garrido A.C.B.
        Effect of adding interferential current in an exercise and manual therapy program for patients with unilateral shoulder impingement syndrome: A randomized clinical trial.
        J Manipulative Physiol Ther. 2018; 41: 218-226
        • Gomes C.
        • Dibai-Filho A.V.
        • Politti F.
        • Gonzalez T.O.
        • Biasotto-Gonzalez D.A.
        Combined use of diadynamic currents and manual therapy on myofascial trigger points in patients with shoulder impingement syndrome: A randomized controlled trial.
        J Manipulative Physiol Ther. 2018; 41: 475-482
        • Celik D.
        • Akyuz G.
        • Yeldan I.
        Comparison of the effects of two different exercise programs on pain in subacromial impingement syndrome.
        Acta Orthop Traumatol Turc. 2009; 43: 504-509
        • Nazligul T.
        • Akpinar P.
        • Aktas I.
        • Unlu Ozkan F.
        • Cagliyan Hartevioglu H.
        The effect of interferential current therapy on patients with subacromial impingement syndrome: A randomized, double-blind, sham-controlled study.
        Eur J Phys Rehabil Med. 2018; 54: 351-357
        • Pasin T.
        • Ataoglu S.
        • Pasin O.
        • Ankarali H.
        Comparison of the effectiveness of platelet-rich plasma, corticosteroid, and physical therapy in subacromial impingement syndrome.
        Arch Rheumatol. 2019; 34: 308-316
        • Subaşı V.
        • Çakır T.
        • Arıca Z.
        • et al.
        Comparison of efficacy of kinesiological taping and subacromial injection therapy in subacromial impingement syndrome.
        Clin Rheumatol. 2016; 35: 741-746
        • Rueda Garrido J.C.
        • Vas J.
        • Lopez D.R.
        Acupuncture treatment of shoulder impingement syndrome: A randomized controlled trial.
        Complement Ther Med. 2016; 25: 92-97
        • Onat Ş.S.
        • Biçer S.
        • Şahin Z.
        • Türkyilmaz A.K.
        • Kara M.
        • Demir S.Ö.
        Effectiveness of kinesiotaping and subacromial corticosteroid injection in shoulder impingement syndrome.
        Am J Phys Med Rehabil. 2016; 95: 553-560
        • Lewis J.
        • Sim J.
        • Barlas P.
        Acupuncture and electro-acupuncture for people diagnosed with subacromial pain syndrome: A multicentre randomized trial.
        Eur J Pain. 2017; 21: 1007-1019
        • Kocyigit F.
        • Acar M.
        • Turkmen M.B.
        • Kose T.
        • Guldane N.
        • Kuyucu E.
        Kinesio taping or just taping in shoulder subacromial impingement syndrome? A randomized, double-blind, placebo-controlled trial.
        Physiother Theory Pract. 2016; 32: 501-508
        • Kaya D.O.
        • Baltaci G.
        • Toprak U.
        • Atay A.O.
        The clinical and sonographic effects of kinesiotaping and exercise in comparison with manual therapy and exercise for patients with subacromial impingement syndrome: A preliminary trial.
        J Manipulative Physiol Ther. 2014; 37: 422-432
        • Kang F.J.
        • Chiu Y.C.
        • Wu S.C.
        • Wang T.G.
        • Yang J.L.
        • Lin J.J.
        Kinesiology taping with exercise does not provide additional improvement in round shoulder subjects with impingement syndrome: A single-blinded randomized controlled trial.
        Phys Ther Sport. 2019; 40: 99-106
        • Johansson K.M.
        • Adolfsson L.E.
        • Foldevi M.O.
        Effects of acupuncture versus ultrasound in patients with impingement syndrome: Randomized clinical trial.
        Phys Ther. 2005; 85: 490-501
        • Johansson K.
        • Bergstrom A.
        • Schroder K.
        • Foldevi M.
        Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care—a randomized clinical trial.
        Fam Pract. 2011; 28: 355-365
        • Göksu H.
        • Tuncay F.
        • Borman P.
        The comparative efficacy of kinesio taping and local injection therapy in patients with subacromial impingement syndrome.
        Acta Orthop Traumatol Turc. 2016; 5: 483-488
        • Galace de Freitas D.
        • Marcondes F.B.
        • Monteiro R.L.
        • Rosa S.G.
        • Maria de Moraes Barros Fucs P.
        • Fukuda T.Y.
        Pulsed electromagnetic field and exercises in patients with shoulder impingement syndrome: A randomized, double-blind, placebo-controlled clinical trial.
        Arch Phys Med Rehabil. 2014; 95: 345-352
        • Arias-Buría J.L.
        • Fernández-de-las-Peñas C.
        • Palacios-Ceña M.
        • Koppenhaver S.L.
        • Salom-Moreno J.
        Exercises and dry needling for subacromial pain syndrome: A randomized parallel-group trial.
        J Pain. 2017; 18: 11-18
        • Apeldoorn A.T.
        • Kamper S.J.
        • Kalter J.
        • Knol D.L.
        • Van Tulder M.W.
        • Ostelo R.W.
        Rigid shoulder taping with physiotherapy in patients with subacromial pain syndrome: A randomized controlled trial.
        J Rehabil Med. 2017; 49: 347-353
        • Lu G.
        • Ades A.E.
        Combination of direct and indirect evidence in mixed treatment comparisons.
        Stat Med. 2004; 23: 3105-3124
        • Lin L.
        • Zhang J.
        • Hodges J.S.
        • Chu H.
        Performing Arm-Based Network Meta-Analysis in R with the pcnetmeta Package.
        J Stat Softw. 2017; 80: 5
        • Wei Y.
        • Higgins J.P.
        Bayesian multivariate meta-analysis with multiple outcomes.
        Stat Med. 2013; 32: 2911-2934
        • Harrer M.
        • Cuijpers P.
        • Furukawa T.A.
        • Ebert D.D.
        Doing meta-analysis in R: A hands-on guide.
        Chapman & Hall/CRC Press, Boca Raton, FL and London2021
        • Higgins J.P.
        • Jackson D.
        • Barrett J.K.
        • Lu G.
        • Ades A.E.
        • White I.R.
        Consistency and inconsistency in network meta-analysis: Concepts and models for multi-arm studies.
        Res Synth Methods. 2012; 3: 98-110
        • Henseler J.F.
        • Kolk A.
        • Van Der Zwaal P.
        • Nagels J.
        • Vliet Vlieland T.P.M.
        • Nelissen R.G.H.H.
        The minimal detectable change of the Constant score in impingement, full-thickness tears, and massive rotator cuff tears.
        J Shoulder Elbow Surg. 2015; 24: 376-381
        • Jones I.A.
        • Togashi R.
        • Heckmann N.
        • Vangsness Jr., C.T.
        Minimal clinically important difference (MCID) for patient-reported shoulder outcomes.
        J Shoulder Elbow Surg. 2020; 29: 1484-1492
        • Tashjian R.Z.
        • Shin J.
        • Broschinsky K.
        • et al.
        Minimal clinically important differences in the American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale pain scores after arthroscopic rotator cuff repair.
        J Shoulder Elbow Surg. 2020; 29: 1406-1411
        • Akgün K.
        • Birtane M.
        • Akarirmak Ü.
        Is local subacromial corticosteroid injection beneficial in subacromial impingement syndrome?.
        Clin. Rheumatol. 2004; 23: 496-500
        • Aydin A.
        • Yildiz V.
        • Topal M.
        • Tuncer K.
        • Köse M.
        • Şenocak E.
        Effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome.
        Turk J Med Sci. 2014; 44: 871-874
        • Bariş Bayram K.
        • Bal S.
        • Safa Satoglu I.
        • et al.
        Does suprascapular nerve block improve shoulder disability in impingement syndrome? A randomized placebo-contolled study.
        J Musculoskelet Pain. 2014; 22: 170-174
        • Beard D.J.
        • Rees J.L.
        • Cook J.A.
        • et al.
        Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): A multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial.
        Lancet. 2018; 391: 329-338
        • Bhayana H.
        • Mishra P.
        • Tandon A.
        • Pankaj A.
        • Pandey R.
        • Malhotra R.
        Ultrasound guided versus landmark guided corticosteroid injection in patients with rotator cuff syndrome: Randomised controlled trial.
        J Clin Orthop Trauma. 2018; 9: S80-S85
        • Björnsson Hallgren H.C.
        • Adolfsson L.E.
        • Johansson K.
        • Öberg B.
        • Peterson A.
        • Holmgren T.M.
        Specific exercises for subacromial pain.
        Acta Orthop. 2017; 6: 600-605
        • Brox J.I.
        • Gjengedal E.
        • Uppheim G.
        • et al.
        Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): A prospective, randomized, controlled study in 125 patients with a follow-up.
        J Shoulder Elbow Surg. 1999; 8: 102-111
        • Christiansen D.H.
        • Frost P.
        • Falla D.
        • et al.
        Effectiveness of standardized physical therapy exercises for patients with difficulty returning to usual activities after decompression surgery for subacromial impingement syndrome: Randomized controlled trial.
        Phys Ther. 2016; 96: 787-796
        • Dilek B.
        • Gulbahar S.
        • Gundogdu M.
        • et al.
        Efficacy of proprioceptive exercises in patients with subacromial impingement syndrome: A single-blinded randomized controlled study.
        Am J Phys Med Rehabil. 2016; 95: 169-182
        • Ellegaard K.
        • Christensen R.
        • Rosager S.
        • et al.
        Exercise therapy after ultrasound-guided corticosteroid injections in patients with subacromial pain syndrome: A randomized controlled trial.
        Arthritis Res Ther. 2016; 18: 129
        • Farfaras S.
        • Sernert N.
        • Hallstrom E.
        • Kartus J.
        Comparison of open acromioplasty, arthroscopic acromioplasty and physiotherapy in patients with subacromial impingement syndrome: A prospective randomised study.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2181-2191
        • Henkus H.E.
        • de Witte P.B.
        • Nelissen R.G.
        • Brand R.
        • van Arkel E.R.
        Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: A prospective randomised study.
        J Bone Joint Surg Br. 2009; 91: 504-510
        • Husby T.
        • Haugstvedt J.R.
        • Brandt M.
        • Holm I.
        • Steen H.
        Open versus arthroscopic subacromial decompression: A prospective, randomized study of 34 patients followed for 8 years.
        Acta Orthop Scand. 2003; 74: 408-414
        • Jarvela T.
        • Jarvela S.
        Long-term effect of the use of a pain pump after arthroscopic subacromial decompression.
        Arthroscopy. 2008; 24: 1402-1406
        • Ketola S.
        • Lehtinen J.
        • Arnala I.
        • et al.
        Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome? A two-year randomised controlled trial.
        J Bone Joint Surg Br. 2009; 91: 1326-1334
        • Kim S.J.
        • Lee H.S.
        Lidocaine test increases the success rates of corticosteroid injection in impingement syndrome.
        Pain Med. 2016; 17: 1814-1820
        • Land H.
        • Gordon S.
        • Watt K.
        Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: A randomized controlled trial.
        Physiother Res Int. 2019; 24: e1768
        • Lu Y.
        • Zhang Q.
        • Zhu Y.
        • Jiang C.
        Is radiofrequency treatment effective for shoulder impingement syndrome? A prospective randomized controlled study.
        J Shoulder Elbow Surg. 2013; 22: 1488-1494
        • Maenhout A.G.
        • Mahieu N.N.
        • De Muynck M.
        • De Wilde L.F.
        • Cools A.M.
        Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome? A randomized, clinical trial.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 1158-1167
        • Marzetti E.
        • Rabini A.
        • Piccinini G.
        • et al.
        Neurocognitive therapeutic exercise improves pain and function in patients with shoulder impingement syndrome: A single-blind randomized controlled clinical trial.
        Eur J Phys Rehabil Med. 2014; 50: 255-264
        • Nejati P.
        • Ghahremaninia A.
        • Naderi F.
        • Gharibzadeh S.
        • Mazaherinezhad A.
        Treatment of subacromial impingement syndrome: Platelet-rich plasma or exercise therapy? A randomized controlled trial.
        Orthop J Sports Med. 2017; 5 (2325967117702366)
        • Paavola M.
        • Malmivaara A.
        • Taimela S.
        • et al.
        Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: Randomised, placebo surgery controlled clinical trial.
        BMJ. 2018; 362k2860
        • Pastora-Bernal J.M.
        • Martin-Valero R.
        • Baron-Lopez F.J.
        • Moyano N.G.
        • Estebanez-Perez M.J.
        Telerehabilitation after arthroscopic subacromial decompression is effective and not inferior to standard practice: Preliminary results.
        J Telemed Telecare. 2018; 24: 428-433
        • Spangehl M.J.
        • Hawkins R.H.
        • McCormack R.G.
        • Loomer R.L.
        Arthroscopic versus open acromioplasty: A prospective, randomized, blinded study.
        J Shoulder Elbow Surg. 2002; 11: 101-107
        • Cift H.
        • Ozkan F.U.
        • Tolu S.
        • Seker A.
        • Mahirogullari M.
        Comparison of subacromial tenoxicam and steroid injections in the treatment of impingement syndrome.
        Eklem Hastalik Cerrahisi. 2015; 26: 16-20
        • Williams Jr., J.W.
        • Holleman Jr., D.R.
        • Simel D.L.
        Measuring shoulder function with the Shoulder Pain and Disability Index.
        J Rheumatol. 1995; 22: 727-732
        • Song A.
        • DeClercq J.
        • Ayers G.D.
        • et al.
        Comparative time to improvement in nonoperative and operative treatment of rotator cuff tears.
        J Bone Joint Surg Am. 2020; 102: 1142-1150
        • Gismervik S.Ø.
        • Drogset J.O.
        • Granviken F.
        • Rø M.
        • Leivseth G.
        Physical examination tests of the shoulder: A systematic review and meta-analysis of diagnostic test performance.
        BMC Musculoskelet Disord. 2017; 18: 41
        • Neer 2nd, C.S.
        Impingement lesions.
        Clin Orthop Relat Res. 1983; : 70-77
        • Yoon T.-H.
        • Choi C.-H.
        • Kim S.-J.
        • Choi Y.-R.
        • Yoon S.-P.
        • Chun Y.-M.
        Attrition of rotator cuff without progression to tears during 2-5 years of conservative treatment for impingement syndrome.
        Arch Orthop Trauma Surg. 2019; 139: 377-382
        • Garvey K.D.
        • Solberg M.J.
        • Cai A.
        • Matzkin E.G.
        Efficacy of corticosteroid injection for subacromial impingement syndrome.
        Ann Joint. 2018; 3 (62-62)
        • Baksh N.
        • Hannon C.P.
        • Murawski C.D.
        • Smyth N.A.
        • Kennedy J.G.
        Platelet-rich plasma in tendon models: A systematic review of basic science literature.
        Arthroscopy. 2013; 29: 596-607