by Logan Swisher, PT, DPT
What is subacromial impingement syndrome?
Subacromial shoulder pain (SSP) is the clinical presentation of pain and/or impairment of shoulder movement and function, usually experienced during shoulder elevation and external rotation. There are multiple structures involved, including the subacromial bursa, the rotator cuff muscles and tendons, the acromion, the coracoacromial ligament, and the capsular and intra-articular tissues. The hypothesized factors include: altered shoulder kinematics, rotator cuff and scapular muscle dysfunction, overuse from sustained intensive work and poor posture that can contribute to the pathogenesis of SSP.
What interventions are suggested for SSP?
The systemic review by Pieters et. Al in March 2020, aimed to evaluate the effectiveness of the following nonsurgical, nonpharmacological treatments: exercise, exercise combined with manual therapy, multimodal physical therapy, corticosteroid injection, laser, ultrasound, extracorporeal shockwave therapy, or pulsed electromagnetic energy. A total of 16 articles were reviewed with 9 out 16 having high quality evidence and 7 out of 16 having moderate quality evidence.
Results
- Exercise: Exercise therapy was effective for improving pain scores, active range of motion and overall shoulder function at short and long term follows ups. Some of the suggested forms of exercise included: scapular stability exercises, rotator cuff strengthening, and shoulder flexibility exercises. The article reported there was a Strong recommendation in favor of exercise therapy for patients with SSP.
- Exercise combined with manual therapy: The article found moderate to high level evidence regarding the reduction of pain in the short term with the combination of exercise and manual therapy. The article concluded a Strong recommendation may be made in favor of exercises combined with manual therapy.
- Multimodal physical therapy: This was defined as the combination of nonsurgical treatment including passive physical modalities, exercises, manual therapy, taping, corticosteroids or electrotherapy. Low level evidence was shown for taping, pulsed electromagnetic field therapy and multimodal care over isolated interventions. The article cited this may be due to the large variety of interventions and therefore multimodal therapy was given only a weak
- Corticosteroid injection: Corticosteroid injection was found to be useful in the short and long term. One study recommended it as a second line of treatment in addition to exercise-based therapies. Overall, the study found a moderate recommendation for corticosteroid injection.
- Laser Therapy: The study found a strong recommendation NOT to use laser therapy in the treatment of SSP.
- Ultrasound: There was only a weak recommendation of ultrasound due to the reviews consistently concluding no evidence for the effectiveness of therapeutic ultrasound.
- Extracorporeal shockwave therapy: Although a moderate recommendation was found, it was consistently concluded that the evidence did NOT support the effectiveness of extracorporeal shockwave therapy.
- Pulsed electromagnetic energy: There is a strong recommendation there is NO evidence to support the effectiveness for the treatment of SSP.
Conclusion
There is strong evidence to support the use of exercise and manual therapy combined with exercise in the treatment of SSP. There is conflicting evidence that surrounds the use of multimodal therapy and corticosteroid injection. Finally, other commonly prescribed non-surgical interventions, such as ultrasound, low level laser, and extracorporeal shockwave therapy all lack evidence of effectiveness. Here at Physical Therapy First, we will work with you to create a program tailored to your individual needs with specific exercises and manual based therapies to treat your subacromial impingement syndrome.
Reference
Pieters L, Lewis J, Kuppens K, Jochems J, Bruijstens T, Joossens L, Struyf F. (2020). An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31726927/