Subacromial Pain Syndrome

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Treatment

Physical Therapy

A Swedish study found good results from a 12 week exercise program for subacromial pain syndrome with a 5 year follow up. Participants were on the waitlist for surgery. They compared a group given non-specific neck and shoulder movement exercises, with a program targeting the strength of the rotator cuff and scapula stabilisers. All patients had tried conservative treatment previously, including physical therapy for many. Among the intervention group 20% ended up having surgery, compared to 63% in the control group. Other outcome measures were also higher in the intervention group. [1][2][3]

They used a pain monitoring model. Using a scale of 0 to 10, the programme allowed pain to go up to 5 out of 10, but if the pain continued to the next morning, or increased over time, then the intensity of exercise was reduced by reducing the resistance. The programme uses eccentric exercises for the rotator cuff, and eccentric/concentric exercises for the scapular stabilisers. The exercise programme is shown in the video below. Shoulder pulleys can be purchased online for example here. It is done twice a day for 8 weeks, then once a day for 4 weeks. Use a resistance where the patient can barely perform 20 repetitions, then use this resistance for 10-15 repetitions for 3 sets.

Injections

Main article: Subacromial Bursa Injection

Surgery

Subacromial decompression was shown to provide no therapeutic benefit over diagnostic arthroscopy in a double blind study in patients who failed conservative treatment with isolated subacromial impingement.[4]

See Also

References

  1. Holmgren et al. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. British journal of sports medicine 2014. 48:1456-7. PMID: 25213604. DOI.
  2. Hallgren et al. A specific exercise strategy reduced the need for surgery in subacromial pain patients. British journal of sports medicine 2014. 48:1431-6. PMID: 24970843. DOI.
  3. Björnsson Hallgren et al. Specific exercises for subacromial pain. Acta orthopaedica 2017. 88:600-605. PMID: 28812398. DOI. Full Text.
  4. Paavola et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ (Clinical research ed.) 2018. 362:k2860. PMID: 30026230. DOI. Full Text.

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