Exploring Conservative Treatments for Subacromial Bursitis: Beyond Surgery

Subacromial bursitis, a common source of shoulder pain, often leads patients and healthcare providers to consider arthroscopic interventions. However, recent studies advocate for a more conservative approach, emphasising physiotherapy interventions that challenge the necessity of surgery. This blog post delves into the effectiveness of non-surgical treatments for subacromial bursitis, highlighting key findings from recent research that support exercise therapy and manual therapy as first-line treatments.

The Role of Exercise Therapy in Managing Subacromial Bursitis
A systematic review published in the Journal of Orthopaedic & Sports Physical Therapy (2020) by Louise Pieters and colleagues, underscores the significant benefit of exercise therapy for patients with subacromial shoulder pain (1). The review, which updated a previous 2013 examination, strongly recommends exercise therapy as the initial treatment strategy to improve pain, mobility, and function. It further suggests that manual therapy could be effectively integrated as an adjunct to exercise, providing a holistic approach to treatment. Interestingly, the review found moderate evidence indicating that other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, and ultrasound, had no significant effect.

Proprioceptive-Based Strategies: A New Frontier
The exploration of proprioceptive-based strategies for treating subacromial impingement syndrome offers a refreshing perspective on managing shoulder pain. A systematic review by Harman Singh, Aaronvir Thind, and Nequesha S Mohamed, published in Cureus (2022), evaluated the effectiveness of kinesiology tape, myofascial trigger point release (MPTR), scapular stabilisation exercises (SSE), and resistance training compared to traditional modalities (2). Their findings reveal that all examined techniques demonstrated some degree of effectiveness in reducing pain and improving function, although the evidence suggests a need for further large-scale studies to solidify these outcomes.

Understanding the Clinical Course of Subacromial Shoulder Pain
A systematic review with meta-analysis conducted by Zohreh Jafarian Tangrood and colleagues, published in 2023, sought to understand the clinical course of pain and function in patients with subacromial pain (3). The study's insights are invaluable, revealing that without intervention, minimal improvement can be expected within the first three months. Conversely, 'usual care' - encompassing a broad range of conservative treatments - showed significant improvement in pain and function up to 12 months, with a substantial portion of this improvement occurring in the first six weeks.

The Effectiveness of Physiotherapy Exercises
The evidence supporting physiotherapy exercises for subacromial impingement syndrome continues to grow, as highlighted in a systematic review and meta-analysis by Hanratty CE and colleagues (4). This comprehensive analysis reinforces the notion that individually tailored physiotherapy exercises can lead to significant improvements in pain and function, further challenging the immediate recourse to surgical interventions.
ConclusionThe shift towards conservative management of subacromial bursitis, particularly through exercise therapy and manual therapy, is backed by a growing body of research. These studies collectively underscore the potential for significant improvements in pain, function, and mobility without the need for surgical intervention. As the healthcare community continues to advocate for evidence-based practices, the emphasis on physical therapy interventions as a first-line treatment offers a promising avenue for patients struggling with subacromial bursitis, advocating for a less invasive, more holistic approach to care.

References

1. Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., & Struyf, F. (2020). An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther, 50(3), 131-141. https://pubmed.ncbi.nlm.nih.gov/31726927/
2. Singh, H., Thind, A., & Mohamed, N. S. (2022). Subacromial Impingement Syndrome: A Systematic Review of Existing Treatment Modalities to Newer Proprioceptive-Based Strategies. Cureus, 14(8). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9509002/
3. Jafarian Tangrood, Z., Gisselman, A. S., Sole, G., & Ribeiro, D. C. (2023). Clinical course of pain and function in subacromial shoulder pain: a systematic review with meta-analysis. https://www.tandfonline.com/doi/full/10.1080/10833196.2023.2192620
4. Hanratty, C. E., McVeigh, J. G., Kerr, D. P., Basford, J. R., Finch, M. B., Pendleton, A., & Sim, J. (2012). The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 42(3), 297-316. https://www.ncbi.nlm.nih.gov/books/NBK116133/