Subacromial Pain Syndrome (SAPS)

what are the Pathoanatomical Diagnoses of Subacromial Pain Syndrome (SAPS)

Subacromial Impingement Syndrome, Rotator Cuff Tendinopathy/Dysfunction, Rotator Cuff Tears, Bicipital Tendinopathy, Superior Labrum Anterior to Posterior (SLAP) Tear

Subacromial Impingement Syndrome (SAIS) is compression of

RC Tendons &/or bursa under:

Acromion

Coracoacromial ligament

Coracoid

AC joint

Subacromial Impingement Syndrome (SAIS) is typically seen to affect mid range shoulder elevation

80-130°, demonstrates painful arc

why is there a relief in SAIS after mid range?

scapular upward rotation & posterior tilting takes over in motion

Shoulder Impingement has Anatomical Contributors such as changes in shape of

acromium, Type 1-3

tendon overload inflammation can cause SAIS, what is the presentation of Neers Stage 1?

Inflammation

Pain and Weakness

Impingement signs

tendon overload inflammation can cause SAIS, what is the presentation of Neers Stage 2?

RC tendinosis

Bursa Fibrosis: Pain & Weakness, Impingement signs

tendon overload inflammation can cause SAIS, what is the presentation of Neers Stage 3?

Osteophyte formation in SA Space

RC tearing: Full Thickness vs Partial Tears, More pain & significant weakness

Signs and Symptoms of SAIS - subjective signs

Pain w/ active elevation

Difficulty sleeping on arm (compression)

Signs and Symptoms of SAIS - objective signs

AROM: painful arc

PROM: may be painless

resisted movements: weak & painful

Does acromial compression contribute to SAPS?

yes, but it is not the only structure involved

What is the source of the symptoms for SAPS?

Symptoms may come from compression, tension, or both

what is the most common mechanism of supraspinatus tears?

bottom up tear, humeral head being pulled into supraspinatus

RC Tendinopathy can occur from tensile overload (Eccentric activities related to throwing, Repetitive manual labor/overhead tasks), which tendon is most commonly involved?

supraspinatus (teres is least affected)

Intrinsic Mechanisms/causes/factors of RC Tendinopathy

Tendon health & quality

Aging, Genetics

Vascular changes: Comorbidities, Tissue Injury

Altered loading: ↑ humeral head migration, Tendon Swelling after acute overload

Extrinsic Mechanisms of RC Tendinopathy

Smoking, Diet

Occupational: Manual Labor, Prolonged Overhead Activity

Athletics: Overhead

Hobbies

Tendinopathy Contributors include

Scapular Dyskinesis: conflicting evidence

posture: flexed posture limits shoulder motion

hypermobility of GH jt: labral tearing, shoulder instability

hypomobility: posterior capsule tightness (anterior shoulder gliding can cause more compress/overload)

which shoulder special test cluster by Michener shows >3/5 (+) tests is clinically significant?

Hawkins-Kennedy, Neers, Painful arc, empty can, ER resistance

what special test involves IR, passive elevation, and scapular depression?

Neers Test (closes SA space)

what special test involves horizontal abduction, IR, 90° elevation?

(max compression of SA space) Hawkins-Kennedy

what special test involves over pressure in IR in scaption position (coils supraspinatus)

empty can special test

resisted ER stresses

supraspinatus & infraspinatus

Posterior Shoulder Impingement is usually seen in OH athletes at

90/90

Pain/pinching during cocking phase of throwing

in the 90/90 position, humerus (Anterior translation of humeral head during cocking phase) pinches posterior capsule between

humeral head & glenoid (Posterior Shoulder Impingement)

Calcific tendinopathy - Supraspinatus has a calcium deposit buildup in rotator cuff tendon, is a result of

chronic tendinopathy, May or may not be a source of pain in of itself (may not change on imaging, but can be pain free)

Management of Cuff Tendinopathy

NSAIDs: (long term tissue degradation, GI bleeding)

Corticosteroid Injection: Efficacy Mixed, Short Term improvements, Potential (-) effects

CSI vs Manual Therapy: Same at 1 yr

intervention focus for high irritability (7/10) pts: Minimize Physical Stress, Activity modification, Monitor impairments &

MT to Shoulder/Cervical Thoracic

Scapular Strengthening (it still works GH)

ROM: AAROM (pulleys)

intervention focus for mod irritability (4-6/10) pts Mild–Moderate Physical Stress: •Address impairments, •Basic-level functional activity restoration intervention focus w/

Tendon Loading of RC: Lower load seems = as effective as higher load (ER, IR)

Scapular Strengthening (rows)

ROM

intervention focus for low irritability (3/10) pts w/ Moderate–High Physical Stress: •Address impairments, •High-demand functional activity restoration w/

Tendon Loading of RC: Lower load seems = as effective as higher load

UE strengthening in most comfortable positions (start w/ dumbbells, OHP, bench) can progress

Scapular Strengthening (loaded Is, Ts, Ys, heavy rows)

ROM -PRN

Functional Training