***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This paper provides an up-to- date overview of the occurrence , diagnosis , risk factors , prognostic indicators and outcome of shoulder disorder ( SD ) , and of the validity and reproducibility of diagnostic classifications and diagnostic imaging techniques for SD . Furthermore , the available evidence on the effectiveness of non-steroidal anti-inflammatory drugs ( NSAIDs ) , corticosteroid injections and physiotherapy for SD is summarized on the basis of r and omized controlled trials with an acceptable quality of their methods . The annual incidence of SD is estimated at about 7 % , its 1-year period prevalence at about 51 % and its lifetime prevalence at about 10 % . While approximately 50 % of all patients with SD seek medical care , about 95 % are treated in primary health care . Of all new episodes of SD presenting to primary care , approximately 50 % seem to resolve within 6 months , while about 40 % seem to persist for up to 12 months . Several prognostic indicators for a favourable or a poor outcome of SD have been identified , but a comprehensive prognostic model is not available . While evidence for the prognostic validity of popular diagnostic classifications of SD is lacking , their reproducibility has been shown to be poor . The accuracy and clinical usefulness of diagnostic imaging techniques appear to be sufficiently verified for SD in secondary care , while their clinical usefulness in primary care and prognostic validity are not . NSAIDs and steroid injections for SD have been shown to be effective within 6 weeks , but their effect on long-term outcome remains unclear . There is very limited evidence for the effectiveness in SD of physiotherapy , including exercise therapy , ultrasound , electrotherapy , laser , mobilization and manipulation OBJECTIVES To compare the effect of grade d physiotherapeutic training of the rotator cuff versus arthroscopic subacromial decompression in patients with subacromial impingement . METHODS R and omised controlled trial with 12 months ' follow up in a hospital setting . Ninety consecutive patients aged 18 to 55 years were enrolled . Symptom duration was between six months and three years . All fulfilled a set of diagnostic criteria for rotator cuff disease , including a positive impingement sign . Patients were r and omised either to arthroscopic subacromial decompression , or to physiotherapy with exercises aim ing at strengthening the stabilisers and decompressors of the shoulder . Outcome was shoulder function as measured by the Constant score and a pain and dysfunction score . " Intention to treat " analysis was used , with comparison of means and control of confounding variables by general equation estimation analysis . RESULTS Of 90 patients enrolled , 84 completed follow up ( 41 in the surgery group , 43 in the training group ) . The mean Constant score at baseline was 34.8 in the training group and 33.7 in the surgery group . After 12 months the mean scores improved to 57.0 and 52.7 , respectively , the difference being non-significant . No group differences in mean pain and dysfunction score improvement were found . CONCLUSIONS Surgical treatment of rotator cuff syndrome with subacromial impingement was not superior to physiotherapy with training . Further studies are needed to qualify treatment choice decisions , and it is recommended that sample s are stratified according to disability level In a r and omized prospect i ve study , we selected 15 patients for arthroscopic subacromial decompression ( ASD ) and 19 patients for open subacromial decompression ( OSD ) . All had impingement syndrome ( Neer grade II ) , and had been unsuccessfully treated without surgery for more than 6 months . The UCLA Shoulder Rating Scale , Visual Analogue Scales for pain and satisfaction , isokinetic dynamometer recordings and physical testing were assessed preoperatively and at 1 ( except isokinetic testing ) , 3 , 6 , and 12 months , and , finally , 8 years after surgery . We found essentially no differences in the clinical tests between the groups during this period . The use of ASD or OSD seems to be a matter of cosmesis and personal preference Objectives : To compare the prognosis of subacromial impingement ( SAI ) stage II treated conservatively or with subacromial decompression . Methods : A follow‐up study after 4–8 years in a r and omized controlled trial ( RCT ) with 90 adult cases with SAI treated in a Danish hospital from 1996 to 2000 with grade d physiotherapy and exercises or arthroscopic subacromial decompression .  Outcomes were proportion of time per year with income transfers ( indexed 0–1 ) , including total transfers ( marginalization ) , sick leave and disability pension obtained from the registry at the Ministry of Work . Self‐reported function , working capability , employment status and global improvement were obtained by question naire in September 2004 . The main outcomes are given as differences in development from baseline . Results : Seventy‐nine ( 88 % ) responded to the question naire and registry data were obtained from 81 . After 1 year the marginalization index increased by 0.45 [ 95 % confidence interval ( CI ) 0.35–0.56 ] for surgery and 0.25 ( 0.16–0.34 ) for physiotherapy . Cases undergoing surgery also tended to have more sick payments during the first year , but the difference was not significant . Four years after inclusion , changes in indices did not differ between treatment groups . Self‐reported outcomes after 4–8 years did not differ between treatment groups . Conclusion : The results of surgical decompression were equal to those of conservative treatment , and the surgery group had more income transferrals during the first year of follow‐up Anterior acromioplasty as described by Neer has been an effective procedure for shoulder impingement syndrome .  Artroscopic acromioplasty is regarded as a technically dem and ing procedure . Since 1988 we have developed a closed percutaneous acromioplasty using motorized instruments . The purpose of this r and omised clinical trial was to compare the results of open and closed percutaneous acromioplasty .  We found a significant improvement in shoulder score , but no differences between the group treated with the open procedure and the group treated with the closed procedure OBJECTIVE To evaluate the effect of surgical treatment of the impingement syndrome of the shoulder on the fitness for work . DESIGN Retrospective . SETTING Academic Hospital Groningen , department of Orthopaedics , the Netherl and s. PATIENTS AND METHODS A group of 31 patients who had undergone an anterior shoulder decompression between 1 January 1984 and 31 December 1993 because of shoulder symptoms due to impingement lasting more than one year , were subjected in January 1996 to a study of the effect of the treatment on the pain , fitness for work and participation in the labour process . The results were measured using an objectivated score list for pain and function and with a comparison of the labour situations before and after the operation as described by the patients . RESULTS End results as measured with the score list were fair to good in 97 patients ( 74 % ) . The numbers of those completely fit for work before operation and at follow-up were identical , viz . 45 out of 131 ( 34 % ) . Thirty-four patients ( 26 % ) had other jobs or adjusted activities and 37 ( 28 % ) were completely unfit for work ( together 71 patients : 54 % ) ; 15 patients ( 11 % ) had stopped working for reasons of age . The probability to be definitely rejected for work after the operation was increased significantly by a job causing shoulder overstrain and by having been on sick leave with pay prior to the operation . CONCLUSION Although the objective results were reasonably good , the percentage of those completely fit for work was not changed appreciably by the surgical treatment OBJECTIVE --To compare the effectiveness of arthroscopic surgery , a supervised exercise regimen , and placebo soft laser treatment in patients with rotator cuff disease ( stage II impingement syndrome ) . DESIGN --R and omised clinical trial . SETTING --Hospital departments of orthopaedics and of physical medicine and rehabilitation . PATIENTS --125 patients aged 18 - 66 who had had rotator cuff disease for at least three months and whose condition was resistant to treatment . INTERVENTIONS --Arthroscopic subacromial decompression performed by two experienced surgeons ; exercise regimen over three to six months supervised by one experienced physiotherapist ; or 12 sessions of detuned soft laser treatment over six weeks . MAIN OUTCOME MEASURES --Change in the overall Neer shoulder score ( pain during previous week and blinded evaluation of function and range of movement by one clinician ) after six months . RESULTS --No differences were found between the three groups in duration of sick leave and daily intake of analgesics . After six months the difference in improvement in overall Neer score between surgery and supervised exercises was 4.0 ( 95 % confidence interval -2 to 11 ) and 2.0 ( -1.4 to 5.4 ) after adjustment for sex . The condition improved significantly compared with placebo in both groups given the active treatments . Treatment costs were higher for those given surgery ( 720 pounds v 390 pounds ) . CONCLUSIONS --Surgery or a supervised exercise regimen significantly , and equally , improved rotator cuff disease compared with placebo Forty-two patients with subacromial impingement syndrome entered a r and omized prospect i ve study comparing  open anterior acromioplasty with a physiotherapy regime . The criterion for a successful outcome of treatment was a reduction of the initial pain score of more than 50 % using the visual analogue scale ( VAS ) technique . The evaluation was performed by an independent observer . At the 6-month follow-up , treatment in the surgical group had been successful in 12/21 ( 57 % ) patients versus 6/18 ( 33 % ) in the physiotherapy group . A one-year evaluation revealed 16/21 ( 76 % ) " successes " in the surgical group . A direct and unbiased comparison with the physiotherapy group was not possible at one year , since 13 patients chose surgery after initial physiotherapy . However , in " an intention to treat " analysis outcome at one year was significantly better in those r and omized to surgery . We found two st and ardized , composite , active movements -- the " Pour out of a Pot " manoeuvre requiring the emptying of a pot of water , and the " H and in Neck " manoeuvre -- to be of predictive value for the outcome of surgery . When combining three pain-related variables into a criterion for prediction of success , a sensitivity of 78 % ( p < 0.02 ) and a specificity of 90 % ( p < 0.03 ) were attained . We advance the hypothesis that pain in the impingement syndrome is mainly elicited by comparison of the subacromial bursa . In some patients a traction-responsive pain generator in the supraspinatus tendon may be present as well The results of open subacromial decompression ( OSD ) were compared with arthroscopic subacromial decompression ( ASD ) after 1 year in 32 subjects ( 4 bilateral ) , and the correlation between the two shoulder rating scales for impingement was documented . Patients were evaluated clinical ly on the modified University of California at Los Angeles ( UCLA ) shoulder rating scale , and Constant scale . Scapular position and rotation were evaluated as well as a rotation and abduction shoulder strength test using the Cybex II dynamometer . No parameters revealed significant differences between the groups , except for the UCLA score which indicated an advantage for the ASD group ( p = 0.046 ) . The OSD group scored 24.5 ( 5.45 ) on the UCLA scale and 73.8 ( 18.9 ) on the Constant scale , whereas the ASD group scored 28.3 ( 5.6 ) and 80.8 ( 16.4 ) . To study the correlation between both scales , the Pearson correlation product-moment coefficient was calculated and a high correlation ( r = 0.81 ) obtained . Less mobility was found in the operated arm for all parameters , with the exception of glenohumeral abduction in both groups and passive elevation in the OSD group . Only in the OSD group did the scapula in the operated extremity show more abduction of the inferior angle of the scapula . Weaker abduction strength in the operated side was found in the ASD group , whereas in the OSD group there was significantly less adduction and external rotation strength at 180 degrees/s en 240 degrees/s . We conclude that after one year the open group tends to catch up with the arthroscopic patients and that the main benefits after arthroscopic surgery as described in literature are more evident in the shorter period The effectiveness of arthroscopic surgery , supervised exercises , and placebo was compared in 125 patients with rotator cuff disease ( impingement syndrome stage II ) in a r and omized clinical trial . The median age was 48 years , and the median duration of complications was 1 to 2 years . The treatments were arthroscopic subacromial decompression performed by 2 experienced surgeons , an exercise regimen supervised for 3 to 6 months by 1 experienced physiotherapist , or 12 sessions of detuned soft laser ( placebo ) for 6 weeks . The criterion for success was a Neer shoulder score > 80 . Fifteen ( 50 % ) and 11 ( 22 % ) of the patients r and omized to placebo and exercises , respectively , had surgery during the 2 1/2-year follow-up period and were classified as having failure with the treatments . The success rate was higher ( P < .01 ) for patients r and omized to surgery ( 26 of 38 ) and exercises ( 27 of 44 ) compared with the placebo group ( 7 of 28 ) . The odds ratio for success after surgery compared with exercises was 1.5 ( 95 % confidence interval 0.6 to 3.7 ; P = .49 ) . Including all patients who underwent operation , the success rate in those not on sick leave ( 19 of 21 ) before 
    Output:
    
According to the best- evidence synthesis , however , there is no evidence from the available RCTs for differences in outcome in pain and shoulder function between conservatively and surgically treated patients with SIS .