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 received an acromioplasty procedure followed by the same post-operative physiotherapy regime as the strengthening group.
The outcome of the trial is clear, acromioplasty plus post-operative strengthening confers NO added benefit over strengthening alone at all stages from 3 months to 5 years in people with a symptomatic rotator cuff.
The implication of this study is that most people with a painful rotator cuff (with the exception of large and mutilple traumatic full thickness tears with gross loss of strength) should attempt a 3-6 months progressive strengthening program prior to undergoing any surgical procedure. The physio or rehab provider should include exercises specific to the rotator cuff at the appropriate dose that progressively becomes more challenging over time. There should also be associated appropriate education provided to the patient regarding pathology and how best to treat the condition. Self-efficacy should be encourage in order to develop an active strategy of improving condition.