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. 2007 Jan 30;41(4):200–210. doi: 10.1136/bjsm.2006.032524

Table 3 Description of studies included in the systematic review.

Trial Participants Inclusion Exclusion Intervention
Ainsworth (2006)24 10 patients Clinical inclusion: Neurological abnormality affecting the shoulder complex Defined programme involving:
Mean age 76 years all or some of Potentially operable RC tears Active anterior deltoid strengthening, scapular exercises, patient education, adaptation, proprioception, home programme
(range 70‐83 years) positive humeral thrust on elevation, Patients involved in industrial claim or litigation 1 x 30 minute treatment each week for 4 weeks
6 female gross weakness and wasting of the supraspinatus and infraspinatus, infraspinatus lag, rupture of long head biceps Then at 2–3 weekly intervals
4 male Ultrasound confirmation of massive rotator cuff tear (defined as leading edge of tear retracted past glenoid margin) Duration and number of treatments not stated
Onset:
Not stated
Duration of symptoms prior to treatment:
Not stated
Bokor et al (1993)25 53 patients from initial group of 80 patients. Clinical inclusion: Previous or subsequent surgery on the involved shoulder NSAIDs
Mean age at onset 62.2 years Pain and / weakness Strengthening and stretching
(range 45–83 years) Nonoperative course of treatment chosen by patient and clinician Corticosteroid injections (16 shoulders)
13 female Arthrogram confirmation of rotator cuff tear 15 of these continued to have pain at final review
40 male
Onset:
Trauma 40 patients
Duration of symptoms prior to treatment:
39 no history of symptoms prior to onset.
< 3 months – 28 patients
3–6 months – 9 patients
> 6 months – 16 patients
Goldberg et al (2001)26 46 patients Clinical inclusion: Workers compensation claim Education
Mean age 65 years None stated Previous surgery Home strengthening and stretching programme
(SD+11 years) Elective nonoperative management. Strengthening involving: rotator cuff specific exercises,
24 female Ultrasound, MRI or arthrogram confirmation of non‐acute full thickness rotator cuff tear Progressive supine press
22 male Stretching involving:
Onset: flexion, external and internal rotation and cross‐body adduction
Not stated
Duration of symptoms prior to treatment:
No acute tears (time not specified)
Hawkins and Dunlop (1995)27 33 patients available for follow‐up (from initial group of 50) Clinical inclusion: Supervised exercises over a 4‐month period, and home programme, including:
Mean age 59.6 years Not stated Internal and external rotation (with rubber tubing), short and long arc active flexion‐extension exercises,
6 female Clinical assessment: Scapular retraction, supraspinatus drill, diagonal proprioneuromuscular facilitation patterns with weights
27 male Muscle wasting Strengthening exercises and proprioceptive patterning
Onset: ‘Pop‐eye' deformity
Traumatic 21 Active and passive movement
Non‐traumatic 12 Drop arm sign
Duration of symptoms prior to treatment: Strength tests
1 month to 30 years Double contrast arthrogram confirmation of rotator cuff tear
Heers et al (2005)28 34 patients recruited Clinical inclusion: X‐ray or MRI finding of subacromial spur Home‐based graduated exercise programme involving: 3 warm‐up exercises, 4 stretching exercises, 5 strengthening exercises
23 female Neer Impingement Sign Younger than 40 years The home programme required 40 minutes per day for 12 weeks
13 male and / or Older than 70 years
Mean age 60.4 years (range 44–69) Hawkins and Kennedy Test Previous surgery
Onset: Clinical assessment No analgesia permitted during 12‐week programme
Not stated Range of movement:
Duration of symptoms prior to treatment: external rotation, flexion, abduction
Group I: 30.4 (SD = 34.5) months Ultrasound
Group II: 28.8 (SD = 23.9) months
Group III: 71.0 (SD = 48.3) months
Itoi and Tabata (1992)29 114 patients (124 shoulders) recruited Clinical inclusion: Fracture or fracture dislocation of shoulder Various combinations of: rest, NSAIDs, steroid injection (repeated to a maximum of 4 times)
55 Female None stated After the symptoms had subsided: active and passive range of motion, and muscle strengthening exercises started
59 Male Clinical assessment: Mean treatment period: 26 months (range 1–83 months)
Onset: Impingement test
Not stated Palpation tenderness
Duration of symptoms prior to treatment: Muscle atrophy
Acute tears (<3 weeks) [15 shoulders] Night pain
3 weeks to 3 months [19 shoulders] Motion pain
3 months to 12 months [19 shoulders] Arthrogram confirmation of rotator cuff tear
> 12 months [9 shoulders] 6 patients with traumatic anterior dislocation of the shoulder were also included
Koubaa et al (2005)30 Case series of 24 patients Clinical inclusion: Analgesics for mild pain, analgesics and NSAID (Piroxicam 20 mg/day for 14 days) for stronger pain
15 female None stated Corticosteroid injection if medications did not reduce pain
9 male Clinical assessment When pain was controlled rehabilitation programme commenced (3 times per week for 2 months)
Mean age 59 years (range 44–83 years) Pain at rest This included:
Onset: Pain with activity Pulsed ultrasound for 10 minutes and cervical massage prior to each treatment
Chronic degenerative changes Pain at night Passive range of movement exercises.
Duration of symptoms prior to treatment: Range of movement Humeral head depressor exercises (pectoralis major and latissimus dorsi).
Mean 9.1 (SD = 12.3) months (range 3–32 months) Impairment (VAS) Abduction exercises
Subjective benefit rated as: effective or very effective, little effect, not effective Proprioceptive exercises
Returned to work on other functional activities Education (avoid shoulder flexion and sustained or repetitive overhead activities).
All patients had refused surgical repair Biofeedback exercises
Ultrasound
Palmer (1998)31 Single case study Clinical inclusion: None stated Active water‐based exercises including stretching and strengthening and swimming for 3.5 months, divided into two phases
1 female None stated Phase I: Water‐based progressive resistance exercises, range of movement exercises, breast‐stroke
78 years (Recommendation for surgery following medical examination) Phase II: Overhead curl
Onset: MRI confirmation of FTT supraspinatus Commenced at week 8
Head‐on motor vehicle collision Patient seen on 10 occasions in clinic and continued programme at home in own therapeutic pool
Duration of symptoms prior to treatment:
6.5 months
Piccoli and Hasson (2004)32 Single case study Clinical inclusion: Physical therapy 3 times per week for 7 weeks (19 visits)
1 female Full can test Phase I
Age 76 years Drop arm test Pulsed ultrasound, isometric shoulder exercises, active assisted movements, isokinetic exercises, scapular exercises, home programme and ice
Onset: Neer sign Phase II
Fall Clinical assessment: Isokinetic exercises, scapular exercises, active assisted exercises against gravity, active exercises, free weights, resistance tubing exercises
Duration of symptoms prior to treatment: Forward head posture Phase III
1 week Scapular symmetry Functional exercises, proprioceptive neuromuscular facilitation.
Range of movement
VAS (pain)
Shoulder muscle strength
MRI confirmation of FTT supraspinatus (5.0 cm)
Yamada et al (2000)33 Case series of 13 patients choosing conservative treatment Clinical inclusion: Weeks 1–3 sling for comfort
5 female Not stated CS injection (1–2/week; up to 15 injections in total)
9 male Arthrography Hotpacks
Mean age 70 years (range 55–81 years) Passive range of movement for flexion and external rotation
Onset: Rotator cuff strengthening exercises
Not stated Injection, heat, exercise, passive movement
Duration of symptoms prior to treatment:
Mean 44 months (range 12 months to 11 years)