Prognostic factors in patients with rotator tendinosis (stage II impingement syndrome) of the shoulder

Objective - To evaluate prognostic factors in patients with rotator tendinosis (stage II impingement syndrome) of the shoulder. Design - Analytic retrospective study of factors associated with success or failure of treatment. Setting - Departments of orthopaedics and physical medicine and rehabilitation. Participants - 125 patients aged 18-66 who had rotator tendinosis resistant to treatment in primary health care; some had active treatment (arthroscopic surgery or a supervised exercise regimen), some not (placebo laser or withdrawal from active treatment). Predictors - Medication, sickness leave, physical and psychosocial measures at baseline. Results - Active treatment, not on sickness leave, and not on regular medication were the best independent prognostic factors, with an estimated odds ratio for success of 4.8 (1.7 to 13.6), 4.4 (1.6 to 12.1), and 4.2 (1.5 to 11.1), respectively. Reported shoulder-related work demands did not alter the impact of sickness leave. The influence of regular medication was particularly high in those who had no disease apart from the painful shoulder (odds ratio 17.0). Patients who had taken medication for the painful shoulder regularly during the previous year, usually chose two or three agents from the following groups: analgesics, benzodiazepines, muscle relaxants, and antiinflammatory drugs. Conclusion - Prognosis for rotator tendinosis is improved by active treatment and a more restricted prescription of medication and sick leave. Polymedication should be avoided.