Each strengthening exercise was repeated 15 times in 3 sets twice daily for 8 weeks and then once daily for 4 weeks. The stretch was selleckchem completed for 30 to 60 seconds and repeated 3 times twice daily. Training load was progressed using weights or elasticised bands. The control group exercise program consisted of 6 non-specific movement exercises for the neck and

shoulder (e.g. neck retraction, shoulder abduction). The control group exercises were not loaded or progressed and were completed 10 times 3 times daily. Outcome measures: The primary outcome was the Constant shoulder score at 3 months. The Constant score is scored from 0 to 100 with a higher score indicating better function. Secondary

outcome measures included the disability of the arm, shoulder and hand questionnaire (DASH), check details a visual analogue score for pain, the EuroQol quality of life instrument, and whether the participant thought they still needed surgery. Results: 97 participants completed the study. At 3 months, the change in Constant score was significantly more in the specific exercise group than the control group by 15 (95% CI 8.5 to 20.6) points. The DASH improved significantly more in the intervention than the control group by 8 (95% CI 2.3 to 13.7) points. The intervention group also improved significantly more than the control group in ratings of night pain, and quality of life. A lower proportion of the specific exercise group subsequently chose surgery (20% v 63%, Number Needed to Treat 3, 95% CI 1.6 to 3.9). Conclusion: A specific, progressive exercise program focusing on training the rotator cuff and scapular stabilisers was effective in improving function, reducing pain and reducing the need of surgery for patients with chronic subacromial impingement syndrome. [Numbers needed to treat and 95% CIs calculated by the CAP Editor.] Controversy persists regarding the pathoaetiology

and even existence of subacromial impingement syndrome (Lewis 2011). Exercise Methisazone has been shown to achieve comparable results to injection therapy and surgery in the treatment of shoulder pain syndrome, at substantially reduced economic burden when compared with the latter. Combined injection and exercise therapy has not been shown to achieve better results than exercise alone at 12 weeks (Crawshaw et al 2010); and injection therapy and exercise therapy achieved comparable results at 6 months (Hay et al 2003). This study provides further evidence for the benefit of exercise, with a specific program conferring enhanced clinical benefit. The authors are to be commended for their insightful contribution to the body of knowledge required to treat shoulder pain effectively. However consideration needs to given to issues pertaining to the study design.