Subacromial pain syndrome

What is it?

SAPS is an umbrella term covering all non-traumatic shoulder problems around/under the acromion, usually unilateral, which are irritated by lifting the arm.

SAPS is best described as pain which presents from the tissues and structures which lie in the space between the acromion (a bony prominence at the top of the shoulder blade) and the humeral head (the part of the upper arm which articulates with the shoulder blade).

SAPS encompasses conditions relating to structures which lie in this ‘subacromial’ space, such as:

• Subacromial bursitis
• Calcific tendonitis
• Rotator cuff tendinopathy / tears / degeneration
• Biceps tendinopathy

How common is it?

SAPS is the most common disorder of the shoulder and accounts for somewhere between 44% to 65% of shoulder pain complaints.

Incidence of SAPS increases with age, peaking in the 6th decade of life.

How does it come about?

Contributing factors for SAPS include both intrinsic factors (unfortunately mostly non-modifiable) and extrinsic factors (fortunately potentially modifiable).

Intrinsic include:

• Genetics
• Quality of the tendon
• Age

Extrinsic include:

• Muscle quality and performance
• Posture / ergonomics
• Shoulder joint movement

Clinical presentation

Patients who present with SAPS are often over the age of 40, suffering from persistent shoulder pain without any known injury / trauma to the shoulder joint.

These patients complain of pain when lifting the affected arm out to the side, reaching high for objects, lifting objects overhead or lying on the affected side.

Often the pain is of a gradual onset.

What can be done about it?

Physiotherapy management is first line treatment of SAPS.

A physio will take a detailed history of the condition and conduct a thorough examination to diagnose.

Management of the condition will be dependent on, and tailored for patient characteristics including age, level of activity, general health and specific goals.

Treatment will include a combination of education, relative rest, hands on treatment for pain relief and a targeted strengthening program focusing on shoulder mobility, posture and strengthening / neuromuscular exercises.

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