Do you have Subacromial Impingement?

Rethinking Shoulder Pain: From Impingement to Subacromial Pain

Shoulder pain ranks as the third most common musculoskeletal complaint, with “impingement” often being the primary diagnosis. Typical symptoms of shoulder impingement include pain when lifting or lowering your arm, reaching, and experiencing achiness at night, especially when lying on the affected side.

The Traditional Understanding

Traditionally, these symptoms were thought to stem from a narrowing of the ‘subacromial space,’ the area in the shoulder joint housing the rotator cuff tendons and bursa. This narrowing was believed to cause these structures to impinge against the underside of the acromion, the bony shelf at the top of the shoulder joint. Consequently, treatments focused on increasing the subacromial space to reduce impingement, including surgical decompression to remove some bone from the joint’s top.

Challenging the Traditional Theory

However, a Cochrane review published in 2019 found with high certainty that subacromial decompression surgery does not provide benefits in pain, function, or quality of life when compared to a placebo. Additionally, a 2021 study by Paavola et al. followed patients for five years post-surgery and found no difference compared to placebo surgery (sham or fake surgery).

Rethinking the Cause of Pain

This raises a crucial question: If shoulder pain is due to impingement, why doesn’t increasing the subacromial space alleviate the pain? A systematic review and meta-analysis published in 2020 provided an answer. It analyzed studies on shoulder pain caused by subacromial impingement and found no difference in subacromial space between those with shoulder pain and those without.

Moving Beyond the Impingement Theory

The authors of the Paavola study suggest that “the impingement theory has become antiquated” and advocate for abandoning the term “Shoulder Impingement” in favor of “Subacromial Pain.”

Effective Treatment Strategies

So, what should we do about it? Good news! A systematic review published in 2020 in the Journal of Orthopaedic and Sports Physical Therapy concluded that the best treatment for Subacromial Pain is exercise. The exercise program should include resistance exercises, and manual therapy is beneficial when used alongside the exercise regimen. However, there is no quick fix, and the expected duration of rehabilitation is around 12 weeks. Patience is a virtue!

By understanding and embracing this new perspective, we can better address shoulder pain and improve patient outcomes through targeted exercise and manual therapy.