Subacromial decompression in patients with shoulder impingement with an intact rotator cuff: An expert consensus statement using the modified Delphi Technique comparing North American to European shoulder surgeons. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Hohmann, E., Glatt, V., Tetsworth, K., Alentorn-Geli, E., Bak, K., Beitzel, K., Boe, B., Calvo, E., Di Giacomo, G., Favard, L., Franceschi, F., Funk, L., Glanzmann, M., Imhoff, A., Ladermann, A., Levy, O., Ludvigsen, T., Milano, G., Moroder, P., Rosso, C., Siebenlist, S., Abrams, J., Arciero, R., Athwal, G., Burks, R., Gillespie, R., Kibler, B., Levine, W., Mazzocca, A., Millett, P., Ryu, R., Safran, M., Sanchez-Sotelo, J., Savoie, F. B., Sethi, P., Shea, K., Verma, N., Warner, J. J., Weber, S., Wolf, B. 2021

Abstract

PURPOSE: The purpose of this study was to perform a Delphi consensus for the treatment of patients with shoulder impingement with intact rotator cuff tendons, comparing North American to European shoulder surgeon preferences.METHODS: Nineteen surgeons from North America [NAP] and 18 surgeons from Europe [EP] agreed to participate and answered 10 open-ended questions in rounds 1 and 2. The results of the first two rounds were used to develop a Likert style questionnaire for round 3. If agreement at round 3 was <60% for an item, the results were carried forward into round 4. For round 4 the panel members outside consensus >60%, <80%) were contacted and asked to review their response. The level of agreement and consensus was defined as 80%.RESULTS: There was agreement on the following items: impingement is a clinical diagnosis; a combination of clinical tests should be used; other pain generators must be excluded; radiographs must be part of the work up; MR imaging is helpful; the first line of treatment should always be physiotherapy; a corticosteroid injection is helpful in reducing symptoms; indication for surgery is failure of non-operative treatment for a minimum of 6 months. The NAP were likely to routinely prescribe NSAIDs [NA 89%; EU 35%] and consider steroids for impingement [NA 89%. EU 65%].CONCLUSION: Consensus was achieved for 16 of the 71 Likert items: impingement is a clinical diagnosis and a combination of clinical tests should be used. The first line of treatment should always be physiotherapy, and a corticosteroid injection can be helpful in reducing symptoms. The indication for surgery is failure of non-operative treatment for a minimum of 6 months. The panel also agreed that SAD is a good choice for shoulder impingement if there is evidence of mechanical impingement with pain not responding to non-surgical measures.

View details for DOI 10.1016/j.arthro.2021.09.031

View details for PubMedID 34655764