Evidencebased Summary

• In a review of eight clinical trials (>390 patients), no definitive evidence supports or refutes the efficacy of common interventions, including physiotherapy, NSAIDs, corticosteroid injections, or open and arthroscopic surgery, for rotator cuff tears in adults (Ejnisman et al., 2003) (SOR: A).

• Based on limited data from two quality RCTs, no evidence supports the superiority of conservative versus surgical treatment for subacromial impingement syndrome (Dorrestijn et al., 2009) (SOR: B).

• Review of 14 RCTs evaluating rotator cuff surgery showed no long-term pain benefit of surgical decompression versus exercise programs (Coghlan et al., 2009) (SOR: A).

Figure 30-8 Hawkins test for shoulder impingement is performed by forward-elevating the humerus against the fixed scapula. Pain indicates anterior impingement.

(Courtesy Mark R Hutchinson, MD.)

Figure 30-8 Hawkins test for shoulder impingement is performed by forward-elevating the humerus against the fixed scapula. Pain indicates anterior impingement.

(Courtesy Mark R Hutchinson, MD.)

Figure 30-9 Neer test for shoulder impingement is performed with abduction and internal rotation of the shoulder. Pain indicates lateral impingement.

(Courtesy Mark R Hutchinson, MD.)

Figure 30-9 Neer test for shoulder impingement is performed with abduction and internal rotation of the shoulder. Pain indicates lateral impingement.

(Courtesy Mark R Hutchinson, MD.)

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