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Sub Acromial Pain Syndrome

Updated: Jan 31

SAPS Assessment


SAPS is characterised as unilateral shoulder difficulties that are non-traumatic in origin. SAPS may cause pain locally around the acromion, which is frequently worse during or following lifting of the arm.


There are numerous pathologies that are currently classified within SAPS


SAPS Pathology Categories

  • Sub Acromial Bursitis

  • Calcific Tendinopathy

  • Supraspinatus Tendinopathy / Tendinosis

  • Rotator Cuff Partial-Tear

  • Rotator Cuff Tendon Degeneration

  • Biceps Tendinitis / Tendinopathy

Prognosis (level 1 evidence)

  • There is an association between >3 months duration shoulder pain and poorer outcomes

  • There is an association between being middle aged (45-54) and poorer outcomes

SAPS Occurrence Associations (level 1 evidence)

  • Repetitive movement of the shoulder, hand, wrist at work

  • Work that requires prolonged upper arm strength

  • Vibration exposure at work (High or prolonged)

  • Working with poor shoulder ergonomics / postures

  • Higher Psychosocial work loads (poor job satisfaction)


SAPS Prevention Activity Associations (level 2 evidence)

  • Regular sports activity >3 hours per week for longer than 10 months


Evidence Based Assessments

Level 1 evidence suggests no single assessment can accurately diagnose SAPS. Level 2 evidence indicates a combination of assessments increases the probability of diagnosing SAPS


Assessment Cluster


Hawkins-Kennedy Test

  • General impingement

  • Positive if reproduction of pain








Painful Arc Test

  • General impingement

  • Positive if pain between 60-120 degrees abduction

  • Negative if pain outside of this range






Infraspinatus Muscle Strength Test

  • Rotator Cuff Tear

  • General impingement

  • Positive if patient gives way due to pain or weakness






Supraspinatus Muscle Strength Test

  • Rotator Cuff Tear

  • Positive if patient displays weakness or pain or both compared to contralateral side






Drop Arm Test

  • Rotator Cuff Tear

  • General impingement

  • Positive for Supraspinatus tear if patient unable to lower arm actively





Imaging

Added value of imaging


MRI (level 1 evidence)

  • Sensitivity & Specificity of MRI & Diagnostic Ultrasound are not significantly different

  • MR Arthrography is accurate to rule out partial cuff tears

Diagnostic Ultrasound (level 2 evidence)

  • An accurate method for detection or exclusion of

  • Rotator Cuff Tendinopathy

  • Sub Acromial Bursitis

  • Calcific Tendinopathy

  • Biceps Tendon Rupture

  • Advised as most valuable and cost effective diagnostic imaging



Evidence Based Treatments


Corticosteroid Injection

  • Level 1 Evidence

  • When used in first 8 weeks for reduced pain & improved function

  • Long term benefits are unclear

Shockwave Treatments

  • Level 1 Evidence

  • For Calcific Tendinosis

  • no more effective than other treatments for non calcific SAPS

Exercise Therapy

  • Level 1 Evidence

  • More effective than no treatment at reducing pain and improving function

  • Specific Rotator Cuff & Scapular stabilisation are more effective than generalised exercises




Was the SAPS Assessments helpful ?

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