Treatment of Impingement Syndrome: A Systematic Review of the Effects on Functional Limitations and Return to Work

The goal of this systematic review is to evaluate the effectiveness of different treatments for impingement syndrome and rotator cuff tear on the improvement in functional limitations and concomitant duration of sick leave. A systematic search for clinical trials or controlled studies was conducted with the following text words: should*, rotator cuff, impingement, work, sick leave, disabilit*, function*. Nineteen articles were included in this review. For functional limitations, there is strong evidence that extracorporeal shock-wave therapy is not effective, moderate evidence that exercise combined with manual therapy is more effective than exercise alone, that ultrasound is not effective, and that open and arthroscopic acromioplasty are equally effective on the long term. For all other interventions there is only limited evidence. We found many studies using range of motion and pain as outcome measures but functional limitations were less often used as an outcome measure in this type of research. Duration of sick leave was seldom included as an outcome measure.

This is a preview of subscription content, access via your institution.


  1. 1.

    van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 1995; 54(12): 959–964.

    PubMed  CAS  Article  Google Scholar 

  2. 2.

    Goupille P, Sibilia J, Groupe Rhumatologique Francais de l'Epaule (G.R.E.P.). Local corticosteroid injections in the treatment of rotator cuff tendinitis (except for frozen shoulder and calcific tendinitis). Clin Exp Rheumatol 1996; 14(5): 561–566.

    PubMed  CAS  Google Scholar 

  3. 3.

    Checroun AJ, Dennis MG, Zuckerman JD. Open versus arthroscopic decompression for subacromial impingement. A comprehensive review of the literature from the last 25 years. Bull Hosp Jt Dis 1998; 57(3): 145–151.

    PubMed  CAS  Google Scholar 

  4. 4.

    Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2003; 1: CD004016.

    PubMed  Google Scholar 

  5. 5.

    Desmeules F, Cote CH, Fremont P. Therapeutic exercise and orthopedic manual therapy for impingement syndrome: A systematic review. Clin J Sport Med 2003; 13(3): 176–182.

    PubMed  Article  Google Scholar 

  6. 6.

    Green S, Buchbinder R, Glazier R, Forbes A. Interventions for shoulder pain. Cochrane Database Syst Rev 2000; 2: CD001156.

    PubMed  Google Scholar 

  7. 7.

    Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev 2003; 2: CD004258.

    PubMed  Google Scholar 

  8. 8.

    Ejnisman B, Andreoli CV, Soares BGO, Fallopa F, Peccin MS, Abdalla RJ, Cohen M. Interventions for tears of the rotator cuff in adults. Cochrane Database Syst Rev 2004; 1: CD002758.

    PubMed  Google Scholar 

  9. 9.

    World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization, 2001.

    Google Scholar 

  10. 10.

    Waddell G, Aylward M, Sawney P. Back pain, incapacity for work and social security benefits: An international literature review and analysis. London: Royal Society of Medicine Press, 2002.

    Google Scholar 

  11. 11.

    Strand LI, Ljunggren AE, Haldorsen EM, Espehaug B. The impact of physical function and pain on work status at 1-year follow-up in patients with back pain. Spine 2001; 26(7): 800–808.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Evanoff B, Abedin S, Grayson D, Dale AM, Wolf L, Bohr P. Is disability underreported following work injury?. J Occup Rehabil 2002; 12(3): 139–150.

    PubMed  Article  Google Scholar 

  13. 13.

    Lotters F, Hogg-Johnson S, Burdorf A. Health status, its perceptions, and effect on return to work and recurrent sick leave. Spine 2005; 30(9): 1086–1092.

    PubMed  Article  Google Scholar 

  14. 14.

    Ren XS, Selim AJ, Fincke G, Deyo RA, Linzer M, Lee A, Kazis L. Assessment of functional status, low back disability, and use of diagnostic imaging in patients with low back pain and radiating leg pain. J Clin Epidemiol 1999; 52(11): 1063–1071.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Dionne CE, Von Korff M, Koepsell TD, Deyo RA, Barlow WE, Checkoway H. A comparison of pain, functional limitations, and work status indices as outcome measures in back pain research. Spine 1999; 24(22): 2339–2345.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Chipchase LS, O’Connor DA, Costi JJ, Krishnan J. Shoulder impingement syndrome: Preoperative health status. J Shoulder Elbow Surg 2000; 9(1): 12–15.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: A preliminary report. J Bone Joint Surg Am 1972; 54(24): 41–50.

    PubMed  Google Scholar 

  18. 18.

    Van Tulder M, Furlan A, Bombardier C, Bouter L, The Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine 2003; 28(24): 1290–1299.

    PubMed  Article  Google Scholar 

  19. 19.

    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Control Clin Trials 1996; 17(1): 1–12.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG. The Delphi list: A criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 1998; 51(12): 1235–1241.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Schmitt J, Haake M, Tosch A, Hildebrand R, Deike B, Griss P. Low-energy extracorporeal shock-wave treatment (ESWT) for tendinitis of the supraspinatus. A prospective, randomised study. J Bone Joint Surg Br 2001; 83(6): 873–876.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Schmitt J, Tosch A, Hunerkopf M, Haake M. Die extrakorporale Stowellentherapie (ESWT) als therapeutische Option beim Supraspinatussehnensyndrom? Ein-Jahres-Ergebnisse einer placebokotrollierten Studie. Orthopade 2002; 31(7): 652–657.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Blair B, Rokito AS, Cuomo F, Jarolem K, Zuckerman JD. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am 1996; 78(11): 1685–1689.

    PubMed  CAS  Google Scholar 

  24. 24.

    Adebajo AO, Nash P, Hazleman BL. A prospective double blind dummy placebo controlled study comparing triamcinolone hexacetonide injection with oral diclofenac 50 mg TDS in patients with rotator cuff tendinitis. J Rheumatol 1990; 17(9): 1207–1210.

    PubMed  CAS  Google Scholar 

  25. 25.

    Shibata Y, Midorikawa K, Emoto G, Naito M. Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. J Shoulder Elbow Surg 2001; 10(3): 209–216.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Strobel G. Long-term therapeutic effect of different intra-articular injection treatments of the painful shoulder—Effect on pain, mobility and work capacity. Rehabilitation (Stuttg) 1996; 35(3): 176–178.

    CAS  Google Scholar 

  27. 27.

    Speed CA, Richards C, Nichols D, Burnet S, Wies JT, Humphreys H, Hazleman BL. Extracorporeal shock-wave therapy for tendonitis of the rotator cuff. A double-blind, randomised, controlled trial. J Bone Joint Surg Br 2002; 84(4): 509–512.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Downing DS, Weinstein A. Ultrasound therapy of subacromial bursitis. A double blind trial. Phys Ther 1986; 66(2): 194–199.

    PubMed  CAS  Google Scholar 

  29. 29.

    Vecchio P, Cave M, King V, Adebajo AO, Smith M, Hazleman BL. A double-blind study of the effectiveness of low level laser treatment of rotator cuff tendinitis. Br J Rheumatol 1993; 32(8): 740–742.

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Ludewig PM, Borstad JD. Effects of a home exercise programme on shoulder pain and functional status in construction workers. Occup Environ Med 2003; 60(11): 841–849.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther 2000; 30(3): 126–137.

    PubMed  CAS  Google Scholar 

  32. 32.

    Brox JI, Gjengedal E, Uppheim G, Bohmer AS, Brevik JI, Ljunggren AE, Staff PH. Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): A prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up. J Shoulder Elbow Surg 1999; 8(2): 102–111.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Sachs RA, Stone ML, Devine S. Open vs. arthroscopic acromioplasty: A prospective, randomized study. Arthroscopy 1994; 10(3): 248–254.

    PubMed  CAS  Article  Google Scholar 

  34. 34.

    Spangehl MJ, Hawkins RH, McCormack RG, Loomer RL. Arthroscopic versus open acromioplasty: A prospective, randomized, blinded study. J Shoulder Elbow Surg 2002; 11(2): 101–107.

    PubMed  Article  Google Scholar 

  35. 35.

    Lindh M, Norlin R. Arthroscopic subacromial decompression versus open acromioplasty. A two-year follow-up study. Clin Orthop 1993; (290): 174–176.

  36. 36.

    Anderson NH, Sojbjerg JO, Johannsen HV, Sneppen O. Self-training versus physiotherapist-supervised rehabilitation of the shoulder in patients treated with arthroscopic subacromial decompression: A clinical randomized study. J Shoulder Elbow Surg 1999; 8(2): 99–101.

    Article  Google Scholar 

  37. 37.

    Roddey TS, Olson SL, Gartsman GM, Hanten WP, Cook KF. A randomized controlled trial comparing 2 instructional approaches to home exercise instruction following arthroscopic full-thickness rotator cuff repair surgery. J Orthop Sports Phys Ther 2002; 32(11): 548–559.

    PubMed  Google Scholar 

  38. 38.

    Lastayo PC, Wright T, Jaffe R, Hartzel J. Continuous passive motion after repair of the rotator cuff. A prospective outcome study. J Bone Joint Surg Am 1998; 80(7): 1002–1011.

    PubMed  CAS  Google Scholar 

  39. 39.

    Raab MG, Rzeszutko D, O'Connor W, Greatting MD. Early results of continuous passive motion after rotator cuff repair: A prospective, randomized, blinded, controlled study. Am J Orthop 1996; 25(3): 214–220.

    PubMed  CAS  Google Scholar 

  40. 40.

    Vingard E, Alexanderson K, Norlund A. Swedish Council on Technology Assessment in Health Care (SBU). Chapter 9. Consequences of being on sick leave. Scand J Public Health Suppl 2004; 32(63): 207–15.

    Article  Google Scholar 

  41. 41.

    Burdorf A, Post W, Bruggeling T. Reliability of a questionnaire on sickness absence with specific attention to absence due to back pain and respiratory complaints. Occup Environ Med. 1996; 53(1): 58–62.

    PubMed  CAS  Article  Google Scholar 

  42. 42.

    Fredriksson K, Toomingas A, Torgen M, Thorbjornsson CB, Kilbom A. Validity and reliability of self-reported retrospectively collected data on sick leave related to musculoskeletal diseases. Scand J Work Environ Health 1998; 24(5): 425–431.

    PubMed  CAS  Google Scholar 

  43. 43.

    Severens JL, Mulder J, Laheij RJ, Verbeek AL. Precision and accuracy in measuring absence from work as a basis for calculating productivity costs in The Netherlands. Soc Sci Med 2000; 51(2): 243–249.

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Verbeek JH, van der Weide WE, van Dijk FJ. Early occupational health management of patients with back pain: A randomized controlled trial. Spine 2002; 27(17): 1844–1851; discussion 1851.

    PubMed  Article  Google Scholar 

  45. 45.

    van Poppel MN, de Vet HC, Koes BW, Smid T, Bouter LM. Measuring sick leave: A comparison of self-reported data on sick leave and data from company records. Occup Med (Lond) 2002; 52(8): 485–490.

    Article  CAS  Google Scholar 

  46. 46.

    Bot SD, Terwee CB, van der Windt DA, Bouter LM, Dekker J, de Vet HC. Clinimetric evaluation of shoulder disability questionnaires: A systematic review of the literature. Ann Rheum Dis 2004; 63(4): 335–341.

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Murrell GA, Walton JR. Diagnosis of rotator cuff tears. Lancet 2001; 357(9258): 769–770.

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K. Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am 2004; 86-A(4): 708–716.

    PubMed  Google Scholar 

  49. 49.

    Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am 2005; 87(7): 1446–1455.

    PubMed  Article  Google Scholar 

  50. 50.

    MacDonald PB, Clark P, Sutherland K. An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. J Shoulder Elbow Surg 2000; 9(4): 299–301.

    PubMed  Article  CAS  Google Scholar 

Download references


This study was financially supported by the Erasmus MC Revolving Fund and the Dutch Order of Medical Specialists.

Author information



Corresponding author

Correspondence to Elske Faber.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Faber, E., Kuiper, J.I., Burdorf, A. et al. Treatment of Impingement Syndrome: A Systematic Review of the Effects on Functional Limitations and Return to Work. J Occup Rehabil 16, 6–24 (2006).

Download citation


  • shoulder impingement syndrome
  • functional limitations
  • sick leave
  • systematic review
  • treatment outcome