Physio Penrith Sub Acromial Pain Syndrome Treatment
Treatment of Sub Acromial Pain Syndrome at Sydney Muscle & Joint Physio Penrith
What is sub acromial pain sydnrome?
Sub acromial pain syndrome (SAPS) is a shoulder injury that presents as shoulder pain and often weakness. It is defined as all non-traumatic, usually unilateral, shoulder problems that cause pain, localised around the acromion, often worsening during or subsequent to lifting of the arm. The different clinical and/or radiological names, such as bursitis, tendinosis calcarea, supraspinatus tendinopathy, partial tear of the rotator cuff, biceps tendinitis, or tendon cuff degeneration are all part of sub acromial pain syndrome.
What are the symptoms of sub acromial pain sydnrome?
Sub acromial pain syndrome presents usually presents as non-traumatic one sided shoulder pain that is localised around the front of the shoulder and can often refer down the arm. The shoulder pain and associated weakness can worsen during or subsequent to lifting of the arm, lying on the arm at night and when attempting to stretch the arm across the body.
There is an association between a longer duration of shoulder pain (> 3 months) and poorer outcome, between being middle-aged (45–54 years) and worse outcome and longer duration of symptoms, and type II or III acromion morphology (shape). There are associations between the occurrence of sub acromial pain syndrome and repetitive movements of the shoulder or hand/wrist during work, work that requires much or prolonged strength of the upper arms, hand-arm vibration (high vibration and/or prolonged exposure) at work, working with a poor ergonomic shoulder posture, and a high psychosocial workload.
Psychosocial factors associated with prolonged shoulder complaints are high psychological demands, low control, low social support, low job satisfaction, and high pressure to perform.
There is evidence that regular sporting or physical activity (> 3 h per week for at least 10 months a year) have a preventive effect on the risk of neck and shoulder complaints and (long-term) illness.
How is sub acromial pain sydnrome diagnosed?
In people presenting with shoulder pain no single test is sufficiently accurate to diagnose sub acromial pain syndrome. The inter-rater reliability of the most common tests varies greatly and as such the combination of a number of tests increases the post-test probability of the diagnosis of shoulder pain related to sub acromial pain syndrome.
To determine if the shoulder pain is sub acromial pain syndrome, a combination of the Hawkins-Kennedy test, the painful arc test, and the infraspinatus muscle strength test should be used; and for a rotator cuff tear, the drop-arm test and the infraspinatus and supraspinatus muscle strength tests should be used.
The recommended use of imaging advises ultrasound as the most valuable and cost-effective diagnostic imaging if a first period of non-operative treatment fails. This can be combined with conventional radiography of the shoulder to determine osteoarthritis, osseous abnormalities, and presence/absence of calcium deposits. MRI of the shoulder is indicated when reliable ultrasound is not at hand or inconclusive, and should be used in patients who are eligible for surgical repair of a cuff tear to assess the degree of retraction and atrophied fatty infiltration.
What are the treatment options for sub acromial pain sydnrome?
The best supported non-surgical treatment options for shoulder pain related to sub acromial pain syndrome include:
Corticosteroid injections: in the first 8 weeks, corticosteroid injections are more effective than placebo injections, physiotherapy, or no treatment in reducing pain and improving shoulder function. Corticosteroid injections in the short term are no more effective than NSAIDs in reducing pain. The effect of corticosteroids in the long term (≥ 3 months) is unclear.
Exercise therapy: is more effective than no treatment in reducing pain and improving function of the shoulder.. There appears to be no difference in effectiveness between exercise therapy and home exercises. Exercises specifically focused on rotator cuff and scapular stabilisers appear to be more effective than general exercise therapy.
Massage (myofascial trigger points in the shoulder muscles, or soft tissue) appears to be more effective than placebo or no treatment in reducing pain and improving shoulder function in patients with shoulder pain
Other interventions: oral NSAIDs appear to be more effective than placebo in reducing pain in the first 1–2 weeks. Ultrasound treatment is no more effective than placebo, no treatment, physiotherapy, or exercise therapy. Electrical stimulation has not been shown to be more effective than placebo. Acupuncture treatment appears to be no more effective than placebo and exercise therapy.
What treatment options do the physios at Sydney Muscle & Joint Clinic offer for sub acromial pain sydnrome?
The physiotherapists and exercise physiologists at Sydney Muscle & Joint Clinic Penrith use guideline based, research supported non-surgical interventions to treat shoulder pain related to sub acromial pain syndrome. This includes injuries such as such as sub acromial bursitis, sub deltoid bursitis, rotator cuff tendinosis, supraspinatus tendinopathy, partial tear of the rotator cuff, biceps tendinitis, or tendon cuff degeneration.
Treatment modalities utilised by our Penrith physios will include passive interventions to help reduce pain, irritability and improve range of motion and these include joint mobilisation and muscle release techniques; active interventions target strength and endurance and include progressive exercise therapy.