Surgery is not superior to graded exercise training for treatment of rotator cuff injury, according to results of a comparative trial conducted in Denmark.

In view of their findings, the researchers say they are "now more reluctant to recommend surgery" in patients with rotator cuff injury, Dr. Jens Peder Haahr and colleagues from Herning Hospital write in the Annals of Rheumatic Diseases.

Despite "unconvincing" evidence supporting the superiority of arthroscopic decompression surgery over exercise training, surgical treatment of rotator cuff syndrome has been widely adopted, they note in the paper.

The researchers compared the effect of graded physiotherapeutic exercise training of the rotator cuff versus arthroscopic decompression in 90 patients referred to a specialist for shoulder pain.

A total of 84 patients completed the 1-year follow-up period -- 41 in the surgery group and 43 in the exercise group.

"We found similar improvements in the two treatment groups," the team reports. Improvements in shoulder function and reductions in pain were not markedly different between those who had surgery and those who exercised.

What's needed, the researchers contend, are larger studies with an adequate number of patients to permit subgroup analyzes before recommendations are made about who might benefit from arthroscopic surgery and who might benefit from graded exercise training.

"This ought to be a prerequisite for the continually expanding industry of arthroscopic decompression operations in the shoulder," they write.

SOURCE: Annals of Rheumatic Disease May 2005.