No relationship between the acromiohumeral distance and pain in adults with subacromial pain syndrome: a systematic review and meta-analysis

Soo Whan Park,Lindsay Thompson,Leanda McKenna,Vinicius Cavalheri,Andreas Kjoenoe,Yuan Tai Chen,Birgit Juul-Kristensen

doi:10.1038/s41598-020-76704-z

Soo Whan Park, Lindsay Thompson + Show 5 more

Open Access

https://doi.org/10.1038/s41598-020-76704-z

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Abstract

To determine whether subacromial space (i.e. acromiohumeral distance; AHD, and/or occupation ratio percentage) differs between people with subacromial pain syndrome (SAPS) and those without. To investigate whether there is a correlation between subacromial space and pain or disability in adults with SAPS and whether temporal changes in pain or disability are accompanied by changes in subacromial space. Systematic review and meta-analysis. Fifteen studies with a total of 775 participants were included. Twelve studies were of high quality and three studies were of moderate quality using the modified Black and Downs checklist. There was no between group difference in AHD in neutral shoulder position (mean difference [95% CI] 0.28 [−0.13 to 0.69] mm), shoulder abduction at 45° (−0.02 [−0.99 to 0.96] mm) or 60° (−0.20 [−0.61 to 0.20] mm). Compared to the control group, a greater occupation ratio in neutral shoulder position was demonstrated in participants with SAPS (5.14 [1.87 to 8.4] %). There was no consistent pattern regarding the correlation between AHD and pain or disability in participants with SAPS, and no consistent increase in subacromial space with improvement in pain or disability over time. The results suggest that surgical (e.g. sub-acromial decompression) and non-surgical (e.g. manual therapy, taping, stretching and strengthening) management of subacromial pain syndrome should not focus solely on addressing a potential decrease in subacromial space, but also on the importance of other biopsychosocial factors.

Highlights

To determine whether subacromial space differs between people with subacromial pain syndrome (SAPS) and those without
There was no between group difference in acromiohumeral distance (AHD) at 0° of shoulder abduction (MD = 0.28 mm, 95% confidence interval (CI) −0.13 to 0.69 mm, I2 = 59%) (Fig. 2A)
This systematic review demonstrated no difference in AHD, measured at 0°, 45° and 60° of shoulder abduction, between participants with SAPS and controls with no shoulder pain

Summary

Introduction

To determine whether subacromial space (i.e. acromiohumeral distance; AHD, and/or occupation ratio percentage) differs between people with subacromial pain syndrome (SAPS) and those without. There was no consistent pattern regarding the correlation between AHD and pain or disability in participants with SAPS, and no consistent increase in subacromial space with improvement in pain or disability over time. There has been a debate regarding the mechanism of SAPS as authors in the field have called for a paradigm shift away from using the term ‘impingement’[15,16] to using “SAPS”17 or “rotator cuffrelated shoulder pain”[16] The rationale behind this shift relates to the poor diagnostic accuracy of the individual impingement tests[10], the complexity of the numerous mechanisms and pathologies associated with pain in the Scientific Reports | (2020) 10:20611. If impingement between acromion and humerus is not a mechanism for the development of SAPS, subacromial space should not be related to symptoms, and this needs to be systematically explored

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