Subacromial Pain Syndrome or Impingement (SAPS)


What is Subacromial Pain Syndrome?

Your shoulder joint is a ball and socket joint that is the most mobile joint in the body. It is made up of the head of the humerus (arm bone) and the glenoid fossa (on your shoulder blade) as pictured.

Subacromial Pain Syndrome (SAPS) refers to pain within the space below the acromial arch (on the shoulder blade) and above the humerus (as pictured in red). This space is called the subacromial space. It can also arise in the subcoracoid space (as pictured in orange). The pain most commonly arises when lifting your arm above shoulder height.


Subacromial Pain Syndrome


SAPS is often referred to shoulder impingement; however impingement is a normal anatomical event that occurs every time you raise your arm up. Therefore, the umbrella term subacromial pain syndrome was created, with good reason as it is often difficult to accurately distinguish the true source of pain to an individual structure in the subacromial space.

There are two main areas that generate pain in the subacromial space:

1. Subacromial Arch: compression occurs towards the back between the hard bony acromion and humeral head.

• It can affects the supraspinatus tendon (part of the rotator cuff), the infraspinatus tendon (another part of the rotator cuff) and the bursa (a fluid-filled sac) that overlies these structures. For information on rotator cuff injury, click here.
• Lifting the shoulder forward and turning inwards will often produce pain.

2. Subcoracoacromial Arch: compression occurs more towards the front between the coracoacromial ligament and the humeral head.

• This also affects the supraspinatus tendon and bursa but also parts of the subscapularis tendon (part of the rotator cuff). For information on rotator cuff injury, click here.
• Lifting the shoulder out to the side and turning it inwards will often produce pain

Pain can also be generated in the subcoracoid space: compression occurs between the humerus and coracoid process.

• Pain is often produced by bringing the arm across the body and turning it inwards.


Symptoms of SAPS:

• Gradual onset of sharp pain at the top of the shoulder associated with overhead activities
• Pain with compressive forces to the shoulder (e.g. sleeping on it)
• No pain with movements below shoulder height
• Pain down the arm



Causes of SAPS:

The causes of sub acromial pain fall into two categories:

1. Primary: involves bony anatomy including varying shapes of the acromion and development of osteophytes (bone spurs).

2. Secondary: involves shoulder biomechanics creating the adverse ‘impingement’.

• This is often caused by adverse postural or sport-related adaptations that affect shoulder joint positions and movements. The shoulder either then moves from its optimal position, or doesn’t move enough or quickly enough when the arm is moving.
• Rotator cuff weakness is often a causative factor for these adaptations. Consequently, the deltoid muscle becomes stronger, pulling the head of the humerus up into the acromion and causing the impingement.
• Another cause can be postural tightness of the front shoulder and associated weakness of the posterior shoulder and scapula muscles. This allows a posture that puts the scapular in a forward and downward position again creating a position that leads to excessive compressive forces in the subacromial space.


Assessment of SAPS:

Your All Care Physiotherapist will ask you a series of questions relating to the onset and behaviour of your shoulder pain. They will then complete a comprehensive assessment of your shoulder and other surrounding body parts, which could include:

• Posture
• Muscle bulk
• Range of movement of your shoulder, shoulder blade, neck and thoracic spine
• Biomechanical movement of your shoulder
• Shoulder muscle strength
• Shoulder blade muscle strength
• Special tests for the shoulder


Treatment for SAPS:

Physiotherapy is generally very effective in the treatment of SAPS, although the average recovery time is up to 6months. It is important to distinguish the causative factors of your shoulder pain as different factors require particular treatment methods, and your All Care Physiotherapist will devise an appropriate treatment plan for you, which may include:

• RICE (rest, ice, compression and elevation)
• Anti-inflammatories
• Ultrasound
• Electrical stimulation
• Soft tissue release
• Dry needling
• Shoulder joint mobilisations
• Specific shoulder muscle strengthening program


What Can You Do to Help?

1. Avoid painful positions (e.g. overhead work)

• This will decrease the irritation in your shoulder faster.

2. Shoulder external rotation:

• Stand holding an elastic band tied onto a door in one hand.
• Bring your shoulder blades back and down.
• Keeping your arm by your side, bend your elbow to 90°.
• Keep your elbow tucked into your side and bring your hand out to the side, and return.
• Repeat 10 times.

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3. Long arm row:

• Stand holding an elastic band tied onto a door in both hands.
• Bring your shoulder blades back and down.
• Keeping your arms straight bring your hands back so they are in line with your body, and return.
• Repeat 10 times.

Picture4 Picture5

4. Shoulder Internal Rotation:



To get control of your shoulder pain, call All Care Physiotherapy today on 1300 291 133 and get back to the activities you enjoy!