Shoulder

Subacromial pain syndrome (SAPS)

Mechanism

An umbrella term for pain in the subacromial space, where the supraspinatus tendon and the subacromial-subdeltoid bursa lie. Reduced scapular control and an underperforming rotator cuff narrow the space on elevation.

Recognition

Pain on elevation, with a painful arc between about 60 and 120 degrees, and pain lying on the shoulder. Neer and Hawkins-Kennedy are sensitive but not specific.

Course

The term impingement has been abandoned because it claims a mechanism that is not established. SAPS describes what you observe without fixing the cause, which suits a picture where structure and complaint correlate poorly.

Structures

• Supraspinatus
• Subacromial-subdeltoid bursa
• Infraspinatus

Joints involved

• Shoulder joint (glenohumeral joint)
• Acromioclavicular joint

Clinical tests

• Neer impingement test
• Hawkins-Kennedy test
• Empty can test
• Full can test

Sources

• Magee DJ, Manske RC. Orthopedic Physical Assessment, 7e editie. Elsevier. 2021