[Practice guideline 'Diagnosis and treatment of the subacromial pain syndrome']

Abstract

In shoulder pain there is often no direct relationship between the symptoms and the anatomical substrate; for this reason, the term 'subacromial pain syndrome' (SAPS) is better than 'impingement'. The diagnosis of SAPS can only be made using a combination of tests. Imaging diagnostics, preferably ultrasound, can be carried out if conservative treatment does not give the required result. Acute pain is treated by giving advice and if necessary analgesics; a subacromial injection of glucocorticoids is indicated if symptoms recur or are persistent. Exercise therapy should be specific, of low intensity and high frequency, including eccentric training, scapula stabilization and trigger point massage. Rehabilitation in a specialized unit may be considered if pain maintaining behaviour is playing a role. There is no convincing evidence that surgical treatment is more effective than conservative management and there is no indication for the surgical treatment of asymptomatic rotator cuff tears.