Often a term used to describe shoulder pain, shoulder impingement syndrome was initially described to explain pain within the shoulder as it was thought to be a result of tendons and bursae (fluid filled sacks) being pinched or impinged within the joint.
This is not always the case and has lead to the diagnosis of Sub Acromial Pain Syndrome (rather than impingement) as it is simply pain beneath the acromion that may be a result of a range of pathologies.
Subacromial Pain Syndrome (SAPS) is defined as all non-traumatic, usually unilateral, shoulder problems that cause pain, localized around the acromion, often worsening during or subsequent to lifting of the arm.
There is not a single cause, nor is there usually a mechanism for the injury onset. However, SAPS has been associated with….
These factors can be combined and are associated! For example, poor thoracic spine mobility and shoulder pain and range of motion have been associated (Strunce et al., 2009).
Potential causes of subacromial pain syndrome are……
BUT DOES IT MATTER WHAT’S CAUSING THE PAIN? RARELY! – The rehabilitation protocol will often have the same focus
Guidelines for assessment and treatment were highlighted in a study from 2014 (Diercks et al., 2014).
GOALS FOR REHAB!
Rehabilitation of SAPS must be focused on restoring adequate shoulder position to increase the subacromial space. If the shoulder is rotated forwards and inwards (protracted), if the upper back is stiff and rounded (kyphotic) and if the posterior cuff of the shoulder is weak, it will reduce the space between the acromion and humeral head.
Rehabilitation is focused around regaining an upright mid-back posture and shoulder position. Reboot’s keys for rehab are the following
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Diercks, R., Bron, C., Dorrestijn, O., Meskers, C., Naber, R., de Ruiter, T., Willems, J., Winters, J. and van der Woude, H. (2014). Guideline for diagnosis and treatment of subacromial pain syndrome. Acta Orthopaedica, 85(3), pp.314-322.
Strunce, J., Walker, M., Boyles, R. and Young, B. (2009). The Immediate Effects of Thoracic Spine and Rib Manipulation on Subjects with Primary Complaints of Shoulder Pain. Journal of Manual & Manipulative Therapy, 17(4), pp.230-236.
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