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Background: Physiotherapy management of subacromial impingement syndrome (SAIS) inevitably involves exercise, yet little is known about its effectiveness and which exercises should be prescribed. A meta-review of existing literature reviews concluded that it was unclear whether exercise was an effective treatment strategy for SAIS. This identified the need for an up-to-date, systematic literature review that specifically focused on the effectiveness of exercise and not physiotherapy treatment as a whole. Methods/Results: A systematic review and meta-analysis was subsequently conducted which, for the first time, attempted to quantify the magnitude of the treatment effect of exercise across outcomes such as pain, patient reported function (PRF), strength and quality of life (QoL). Although it was evident that physiotherapy exercises are effective in the management of SAIS, heterogeneity of the exercise interventions alongside poor reporting of exercise protocols, prevented conclusions about which specific components of the exercise protocols were associated with best outcomes. Further exploration regarding specifics of exercise prescription was required. Focus group studies were conducted with the intention of providing more information regarding parameters of an exercise protocol and to explore the perceptions of the therapists regarding the effectiveness of exercise. The focus groups demonstrated that exercise was a fundamental treatment for SAIS, however gaining early buy-in to an active exercise approach was essential. The therapists used patient education regarding SAIS aetiology to foster buy-in and "sell" self-management via exercise.

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Humans are unique amongst the hominoids in having evolved habitual bipedalism. The upper limb has been freed from a locomotor role and has become specialised to perfoming manipulatory tasks. The shoulders of humans and other hominoids are morphologically similar, although the human shoulder includes specialisations representing adaptation to use of the upper limb below the shoulder. The human shoulder joint is susceptible to degenerative joint disease (DJD), most commonly taking the form of rotator cuff disease (RCD). Mention of RCD is extremely rare in the palaeopathological record, and does not represent the spectrum of disease recognised clinically; RCD is entirely absent from literature on non-human primate pathology. Palaeopathology and comparative primate pathology have the potential to provide perspective on DJD in modem humans, as well as providing insight into the relationship between fonn and function.

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