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Sub acromial pain syndrome

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Sub acromial pain syndrome (SAPS) refers to the umbrella term used to describe non-traumatic shoulder pain involving the structures that lie within the the sub acromial space. The sub acromial space involves the area beneath the corcaco-acromial arch (the top of your shoulder joint) to the above the humeral head (the bone of your arm that extends in your elbow).

Causes

The shoulder joint itself is one the most unique in the body, it can move in so many different ways and allows us to do some dynamic actions, think of someone sending down a 150kph fast bowl or breaking an Olympic swimming record! But this is where things can also get tricky, because there are so many moving parts to the shoulder, the function and coordination of each is vital for painfree movement. SAPS can often arise predominantly from overload to the area, and not always to do with exercise. Some examples include:


  • Overhead activities (Painting the house, gardening)

  • Overuse repetition (Throwing too much too soon)

  • Increasing intensity and frequency of activity (i.e. Taking up tennis, swimming ) too quickly

  • SAPS can also occur because of muscular weakness- particularly of your rotator cuff muscles which play a huge role in shoulder mechanics.

There are also some others factors that can determine whether someone is likely to develop SAPS such as; 


  • Age

  • Anatomical structure

  • Natural shoulder laxity/tightness

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Signs & Symptoms

SAPS is often most noticeable when performing overhead movements, and even day-to-day tasks can start to become hard. Some examples include:


  • Brushing/washing hair

  • Taking off jumpers/bras and shirts

  • Driving

  • Reaching for items

When SAPs starts to get worse, it can then start to be painful even when at rest, and you may even notice it during when sleeping.


  • It is often described as a ‘block’ or a ‘pinching’ feeling.

Differential Diagnosis

  • Labral injury

  • Adhesive capsulitis (frozen shoulder)

  • Referred pain coming from the neck/surround areas

  • Arthritis

  • Rotator cuff muscle tear

How to Manage

  • There are various different ways to treat SAPS, which once formally diagnosed your physiotherapist will discuss dependent on your clinical presentation. Here at PROmotion, our ethos is around ‘movement is medicine’, which falls in line with the best evidence regarding the majority of shoulder conditions. 

  • Formulating an individualised rehabilitation program specific to your goals, whether it be swimming to Rottnest or finishing painting the house.

  • Sometimes a combination of manual therapy techniques in conjunction with your individualised rehabilitation program will also be indicated.

References

  1. Garving, C., Jakob, S., Bauer, I., Nadjar, R., & Brunner, U. H. (2017). Impingement Syndrome of the Shoulder. Deutsches Arzteblatt international, 114(45), 765–776. https://doi.org/10.3238/arztebl.2017.0765

  2. Diercks, R., Bron, C., Dorrestijn, O., Meskers, C., Naber, R., de Ruiter, T., Willems, J., Winters, J., van der Woude, H. J., & Dutch Orthopaedic Association (2014). Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta orthopaedica, 85(3), 314–322. https://doi.org/10.3109/17453674.2014.920991

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