Subacromial Pain Syndrome is an umbrella term for non-traumatic, usually unilateral, shoulder problems that produce antero-lateral shoulder pain often worsening during or after lifting the arm.
This term encompasses pain involving one or more structures within the subacromial space. It is thought to represent between 45-65% of all complaints of shoulder pain.
This comprises conditions such as:
- Subacromial bursitis
- Rotator cuff tendinopathy or rotator cuff tears
- Biceps tendinopathy or
- Rotator cuff tendinosis
Three main mechanisms are thought to be involved in the pathogenesis of subacromial pain syndrome:
- Reduced scapular control
- Reduced humeral head control
- Change to the actual size of structures within the subacromial space (rotator cuff tendons, subacromial bursa etc).
Patients will usually present with:
- Weakness (particularly external rotation)
- Limited range of motion (flexion and abduction primarily)
- Pain that radiates down the upper arm (stopping above the elbow)
- Pain worse at night with difficulty sleeping on the affected side.
Three useful tests in clinic to aid in the diagnose subacromial pain syndrome are as follows:
- Hawkins Kennedy
- Taking the patient into internal rotation passively with the arm in 90 abduction and 90 degrees elbow flexion
- Painful arc
- Pain with shoulder abduction from 60 – 120 degrees. Pain should ease towards the top however if it reappears at 170-180 degrees this may indicated ACJ involvement.
- Resisted external rotation in neutral
- Pain +/- weakness with resisted contraction either during or on release.
Initial conservative management would comprise of:
- Relative rest and limitation of aggravating activities
- Strengthening and mobility program to address relevant deficits over an 8-12-week period.
- NSAIDs to help with pain and inflammation
- A cortisone injection is unlikely to be needed as first line management unless pain is severe and preventing the patient from participating in rehabilitation.
Surgical management is usually only considered after a failure of conservative management after 3-6 months.
Matt Delaney – Physio Plus Footscray