Shoulder impingement ("SAPS")
SAPS stands for subacromial pain syndrome, which has now been deemed a more correct term than subacromial impingement when discussing shoulder pain arising from structures within the subacromial space. Impingement within this area is considered a normal component of shoulder function. It is only when this “impingement” becomes painful that we take note and look into it further…
Basic Anatomy:
The shoulder is essentially a ball and socket joint, the movement occurs at the top of the shoulder where the humerus fits into the glenoid, which is a part of the scapula. It is held in place by soft tissues (muscles, tendons and tissue in the joint capsule) which move and rotate the arm, allowing for a wide range of movements. SAPS refers to pain originating from any structure beneath the acromion (bony shelf on scapula) and above the top of the humerus. This space contains many structures including the rotator cuff tendons, the bursa (fluid filled sac that reduces friction) and ligaments. Any of these can become painful due to a variety of reasons.
Symptoms of SAPS:
Patients with SAPS usually report pain over the shoulder joint and/or upper arm. Pain can be constant or intermittent. Symptoms worsen with certain activities, particularly those involving elevation of the arm to shoulder height and above. Lifting the arm away from the body (abduction) can bring on pain, as can lying on the affected side. Symptoms can result in decreased movement, weakness and sleep disturbance. Neck and upper back soreness or stiffness can commonly occur. All of these symptoms can quite quickly start to affect work and daily functions.
Contributing factors:
Aside from the obvious pathologies that can be found with imaging, such as subacromial bursitis and rotator cuff tendinopathy or tearing, there are many possible contributing factors to SAPS, such as…
In fact, any one or more of these factors left unchecked and untreated can lead to degenerative damage or tearing of subacromial structures.
Treatment of SAPS:
Treatment requires us to recognise the factors which have contributed to the development of this condition. We are all different and as we can see from the previous paragraph there are many contributing factors that can lead to SAPS. Therefore, if a treatment programme is to be effective it must be tailored to each individual’s problem.
Subjective history, posture, range of motion, muscle length and strength, cervicothoracic spine mobility and glenohumeral accessory movements must all be examined in these cases. The findings from a thorough assessment will determine the focus of each individual’s treatment and rehabilitation from SAPS.
Techniques employed may include…
- Postural re-education and exercises;
- Stretching;
- Strengthening exercises and scapular stabilisation;
- Spinal mobilisation (which has been shown to assist scapula movement);
- Ultrasound and/or electrotherapy for pain relief;
- Dry needling; and
- Functional task modification
I hope this summary will help you or someone you know. As always, we are here at The Physio Nook to help out with any musculoskeletal disorders you may have, SAPS or otherwise! Feel free to call us, email, or drop in for a great service.
Paul Woodward
Principal Physiotherapist
The Physio Nook.
The shoulder is essentially a ball and socket joint, the movement occurs at the top of the shoulder where the humerus fits into the glenoid, which is a part of the scapula. It is held in place by soft tissues (muscles, tendons and tissue in the joint capsule) which move and rotate the arm, allowing for a wide range of movements. SAPS refers to pain originating from any structure beneath the acromion (bony shelf on scapula) and above the top of the humerus. This space contains many structures including the rotator cuff tendons, the bursa (fluid filled sac that reduces friction) and ligaments. Any of these can become painful due to a variety of reasons.
Symptoms of SAPS:
Patients with SAPS usually report pain over the shoulder joint and/or upper arm. Pain can be constant or intermittent. Symptoms worsen with certain activities, particularly those involving elevation of the arm to shoulder height and above. Lifting the arm away from the body (abduction) can bring on pain, as can lying on the affected side. Symptoms can result in decreased movement, weakness and sleep disturbance. Neck and upper back soreness or stiffness can commonly occur. All of these symptoms can quite quickly start to affect work and daily functions.
Contributing factors:
Aside from the obvious pathologies that can be found with imaging, such as subacromial bursitis and rotator cuff tendinopathy or tearing, there are many possible contributing factors to SAPS, such as…
- Postural dysfunction (particularly increased thoracic kyphosis and “rounded shoulders”);
- Repetitive activities, especially if overhead;
- Anatomical variants, including a curved acromion or bony spurs;
- Acute trauma such as a fall or a “pull” on the arm;
- Faulty exercise/gym/sporting technique;
- Muscle imbalance, such as tight pectorals and weak scapular stabilisers.
In fact, any one or more of these factors left unchecked and untreated can lead to degenerative damage or tearing of subacromial structures.
Treatment of SAPS:
Treatment requires us to recognise the factors which have contributed to the development of this condition. We are all different and as we can see from the previous paragraph there are many contributing factors that can lead to SAPS. Therefore, if a treatment programme is to be effective it must be tailored to each individual’s problem.
Subjective history, posture, range of motion, muscle length and strength, cervicothoracic spine mobility and glenohumeral accessory movements must all be examined in these cases. The findings from a thorough assessment will determine the focus of each individual’s treatment and rehabilitation from SAPS.
Techniques employed may include…
- Postural re-education and exercises;
- Stretching;
- Strengthening exercises and scapular stabilisation;
- Spinal mobilisation (which has been shown to assist scapula movement);
- Ultrasound and/or electrotherapy for pain relief;
- Dry needling; and
- Functional task modification
I hope this summary will help you or someone you know. As always, we are here at The Physio Nook to help out with any musculoskeletal disorders you may have, SAPS or otherwise! Feel free to call us, email, or drop in for a great service.
Paul Woodward
Principal Physiotherapist
The Physio Nook.