https://www.ncbi.nlm.nih.gov/pubmed/23836479 A well conducted Randomised Controlled Trial published in 2013 investigated how supervised exercise (strengthening) compared with surgery (sub-acromial decompression) for the management of rotator cuff releated shoulder pain (subacromial impingement). A total of 140 patients, 70 in each group, were included in the trial. The strengthening group performed a series of progressive strengthening exercises whilst the surgical group rece

For many years the clinical dogma in frozen shoulder has been no matter what you do, after 30 months your shoulder will be better. This has never sat comfortably with me. I understand that natural history is often the greatest healer, but surely there is something that can be done to reduce the time course of the condition and in my experience some poor people have symptoms that last much longer than 30 months! This hunch has proven to be somewhat correct. This systematic rev

This is a quality study conducted in 2014 that showed supervised exercise by a physiotherapist in a cohort of people with frozen shoulder resulted in significant improvements in pain and function. This was compared to independent home exercise and individual multi modal physiotherapy. The improvements in the supervised exercise class were large and happened relatively quickly, with most people beginning to improve in the first 6 weeks. The rationale behind the large improveme

This is a very interesting study exploring the proportion of people in a population who have a rotator cuff tear. The results clearly show that the prevalance of having a rotator cuff tear increases with age. It also categorically shows that most rotator cuff tears are non-painful. The results of the study show that you are twice as likely to have an asymptomatic rotator cuff tear than a painful one. See graphic below: This clearly indicates that just because an image shows y

Cortisone injections are very popular in musculoskeletal medicine for all types of conditions. Specifically at the shoulder, sub-acromial bursa injections are frequent for the management of rotator cuff related shoulder pain/sub-acromial pain syndrome, but what is their effect? This meta-analysis suggests the results are hit and miss. After 3 months there is no difference between a corticosteroid injection (CSI) and a placebo injection. 1 out of every 5 people who receive a C

A very promising study has demonstrated rotator cuff strengthening can reduce pain and improve function in a population of people with frozen shoulder. This is the first study to show this and certainly is a promising finding. Historically, management of frozen shoulder has revolved around passive stretching and injections to reduce inflammation and improve capsular flexibility. This study suggests further research should be devoted to active strengthening of the shoulder. #B