Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis
Language: 
English
Short Title: 
Treatments for shoulder impingement syndrome
Abstract: 

Many treatments for shoulder impingement syndrome (SIS) are available in clinical practice; some of which have already been compared with other treatments by various investigators. However, a comprehensive treatment comparison is lacking. Several widely used electronic databases were searched for eligible studies. The outcome measurements were the pain score and the Constant-Murley score (CMS). Direct comparisons were performed using the conventional pair-wise meta-analysis method, while a network meta-analysis based on the Bayesian model was used to calculate the results of all potentially possible comparisons and rank probabilities. Included in the meta-analysis procedure were 33 randomized controlled trials involving 2300 patients. Good agreement was demonstrated between the results of the pair-wise meta-analyses and the network meta-analyses. Regarding nonoperative treatments, with respect to the pain score, combined treatments composed of exercise and other therapies tended to yield better effects than single-intervention therapies. Localized drug injections that were combined with exercise showed better treatment effects than any other treatments, whereas worse effects were observed when such injections were used alone. Regarding the CMS, most combined treatments based on exercise also demonstrated better effects than exercise alone. Regarding surgical treatments, according to the pain score and the CMS, arthroscopic subacromial decompression (ASD) together with treatments derived from it, such as ASD combined with radiofrequency and arthroscopic bursectomy, showed better effects than open subacromial decompression (OSD) and OSD combined with the injection of platelet-leukocyte gel. Exercise therapy also demonstrated good performance. Results for inconsistency, sensitivity analysis, and meta-regression all supported the robustness and reliability of these network meta-analyses. Exercise and other exercise-based therapies, such as kinesio taping, specific exercises, and acupuncture, are ideal treatments for patients at an early stage of SIS. However, low-level laser therapy and the localized injection of nonsteroidal anti-inflammatory drugs are not recommended. For patients who have a long-term disease course, operative treatments may be considered, with standard ASD surgery preferred over arthroscopic bursectomy and the open surgical technique for subacromial decompression. Notwithstanding, the choice of surgery should be made cautiously because similar outcomes may also be achieved by the implementation of exercise therapy.

Author(s): 
Dong, Wei
Goost, Hans
Lin, Xiang-Bo
Burger, Christof
Paul, Christian
Wang, Zeng-Li
Zhang, Tian-Yi
Jiang, Zhi-Chao
Welle, Kristian
Kabir, Koroush
Item Type: 
Journal Article
Publication Title: 
Medicine
Journal Abbreviation: 
Medicine (Baltimore)
Publication Date: 
2015-03
Publication Year: 
2015
Pages: 
e510
Volume: 
94
Issue: 
10
ISSN: 
1536-5964
DOI: 
10.1097/MD.0000000000000510
Library Catalog: 
PubMed
Extra: 
PMID: 25761173 PMCID: PMC4602475

Turabian/Chicago Citation

Wei Dong, Hans Goost, Xiang-Bo Lin, Christof Burger, Christian Paul, Zeng-Li Wang, Tian-Yi Zhang, Zhi-Chao Jiang, Kristian Welle and Koroush Kabir. 2015-03. "Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis." Medicine 94: 10: e510. 10.1097/MD.0000000000000510.

Wikipedia Citation

<ref> {{Cite journal | doi = 10.1097/MD.0000000000000510 | issn = 1536-5964 | volume = 94 | pages = e510 | last = Dong | first = Wei | coauthors = Goost, Hans, Lin, Xiang-Bo, Burger, Christof, Paul, Christian, Wang, Zeng-Li, Zhang, Tian-Yi, Jiang, Zhi-Chao, Welle, Kristian, Kabir, Koroush | title = Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis | journal = Medicine | date = 2015-03 | pmid = | pmc = }} </ref>