Subacromial Impingement Syndrome

Definition and Diagnosis

The American Academy of Family Physicians defines subacromial impingement syndrome as a condition characterized by compression of soft tissues, primarily the supraspinatus tendon, in the subacromial space between the humeral head and the coracoacromial arch 1
The syndrome affects approximately 1 in 50 adults, being particularly common in athletes who perform repetitive throwing motions and workers who maintain their arms above their head 2
The American Academy of Family Physicians recommends the Hawkins test, which has a sensitivity of 92% and specificity of 25%, and the Neer test, which has a sensitivity of 88% and specificity of 33%, for diagnosis 1

The American Academy of Orthopaedic Surgeons recommends conservative treatment, including therapeutic exercises and non-steroidal anti-inflammatory drugs (NSAIDs), as the initial treatment for subacromial impingement syndrome 3, 4
The use of NSAIDs is recommended alongside exercises as initial treatment 3, 4
The evidence for the efficacy of subacromial corticosteroid injections is conflicting, with five level II studies reporting variable results for periods between 2 and 6 weeks 3, 4
Other therapeutic modalities, such as physical therapy, heat therapy, and electromagnetic field therapy, have limited or conflicting evidence 3, 4, 2, 1
The British Medical Journal states that the current evidence does not support subacromial decompression surgery as a first-line treatment, as it does not provide clinically important improvements in pain, function, or quality of life compared to other treatments 5, 6, 7

The Journal of the American Academy of Orthopaedic Surgeons recommends a treatment algorithm that includes a 3-6 month period of conservative treatment, including exercises and NSAIDs, before considering surgical options 3, 4
If there is no improvement after 3-6 months of conservative treatment, surgical evaluation may be considered, although the current evidence does not show clear benefits of surgery over conservative treatment 5, 6, 7

Implement a structured strengthening program targeting rotator cuff muscles, scapular stabilizers, and periscapular muscles, as recommended by physical therapy guidelines, to address impingement syndrome 8

Include scapular stabilizer strengthening in the exercise program, as scapular dyskinesis contributes significantly to impingement pathology, according to rehabilitation guidelines 8