Subacromial Shoulder Pain Research Articles

Linking pain and disability to kinematic deviations in subacromial shoulder pain

Linking pain and disability to kinematic deviations in subacromial shoulder pain

Randomized feasibility study of an autologous protein solution versus corticosteroids injection for treating subacromial pain in the primary care setting - the SPiRIT trial.

The primary aim of this study was to assess the feasibility of recruiting and retaining patients to a patient-blinded randomized controlled trial comparing corticosteroid injection (CSI) to autologous protein solution (APS) injection for the treatment of subacromial shoulder pain in a community care setting. The study focused on recruitment rates and retention of participants throughout, and collected data on the interventions' safety and efficacy. Participants were recruited from two community musculoskeletal treatment centres in the UK. Patients were eligible if aged 18 years or older, and had a clinical diagnosis of subacromial impingement syndrome which the treating clinician thought was suitable for treatment with a subacromial injection. Consenting patients were randomly allocated 1:1 to a patient-blinded subacromial injection of CSI (standard care) or APS. The primary outcome measures of this study relate to rates of recruitment, retention, and compliance with intervention and follow-up to determine feasibility. Secondary outcome measures relate to the safety and efficacy of the interventions. A total of 53 patients were deemed eligible, and 50 patients (94%) recruited between April 2022 and October 2022. Overall, 49 patients (98%) complied with treatment. Outcome data were collected in 100% of participants at three months and 94% at six months. There were no significant adverse events. Both groups demonstrated improvement in patient-reported outcome measures over the six-month period. Our study shows that it is feasible to recruit to a patient-blinded randomized controlled trial comparing APS and CSI for subacromial pain in terms of clinical outcomes and health-resource use in the UK. Safety and efficacy data are presented.

SPiRIT study protocol (Shoulder Pain: Randomised trial of Injectable Treatments): a randomised feasibility and pilot study of autologous protein solution (APS) vs corticosteroids for treating subacromial shoulder pain

BackgroundThe management of subacromial shoulder pain represents a significant challenge and is typically managed through either physiotherapy, joint injection or surgical intervention. Recent surgical trials have questioned the efficacy and there is a need to improve the evidence base for the non-surgical management of this condition.The study aims to provide evidence of the feasibility of conducting a randomised controlled trial to compare the efficacy of autologous protein solution (APS) against the current standard of care, corticosteroid injection (CSI) for subacromial shoulder pain. Autologous protein solution (APS) is a blood-derived biological injection which has been shown to have anti-inflammatory effects.MethodsA parallel-group two-arm randomised control trial will be conducted, comparing APS and CSI for shoulder pain. Fifty patients will be recruited. Feasibility will be assessed by examination of the conversion rate of eligible participants to the total number of participants recruited, whether it is possible to collect the appropriate outcome measures and the levels of retention/data compliance at follow-up dates.DiscussionCSI is the mainstay of conservative management of subacromial shoulder pain. Trials and systematic reviews have reported differing conclusions, but the consensus view is that any benefits seen from CSI use are most likely to be short-term and there remains a significant number of patients who go on to have surgical intervention despite CSI.Biological injections, such as APS are being increasingly used, in the anticipation they may offer improved longer lasting outcomes for shoulder pain. However, the evidence to demonstrate the comparative efficacy of CSI versus APS does not currently exist. If feasible, a fully powered study will offer clarity to the treatment pathway of thousands of patients each year with subacromial pain.Trial registrationThe study is funded by the National Institute for Health Research–Research for Patient Benefit, NIHR 201473, Trial Registration Number (ISRCTN12536844: SPiRIT. Shoulder pain: randomised trial of injectable treatments–date of Registration 15/9/2021). Protocol Version V1.0_30Jul2021. IRAS Project ID: 294,982.

Adding Manual Therapy to an Exercise Program Improves Long-Term Patient Outcomes Over Exercise Alone in Patients With Subacromial Shoulder Pain: A Randomized Clinical Trial

Adding Manual Therapy to an Exercise Program Improves Long-Term Patient Outcomes Over Exercise Alone in Patients With Subacromial Shoulder Pain: A Randomized Clinical Trial

Exploring the potential of combining kinematics and EMG to enhance identification of individuals with subacromial shoulder pain

Exploring the potential of combining kinematics and EMG to enhance identification of individuals with subacromial shoulder pain

Fear-Avoidance Beliefs Are Associated with Pain Intensity and Shoulder Disability in Adults with Chronic Shoulder Pain: A Cross-Sectional Study.

Shoulder pain is one of the most common musculoskeletal conditions, and for people over 40 years old, it represents the musculoskeletal pain with the greatest impact on quality of life. Psychological factors, such as fear-avoidance beliefs, are associated with musculoskeletal pain, and several studies suggest that they can influence various treatment outcomes. Our objective was to explore the cross-sectional association between fear-avoidance beliefs and shoulder pain intensity and disability in subjects with chronic shoulder pain. A cross-sectional study was conducted, and 208 participants with chronic unilateral subacromial shoulder pain were recruited. The shoulder pain and disability index assessed pain intensity and disability. The Spanish fear-avoidance components scale assessed the presence of fear-avoidance beliefs. The association between fear-avoidance beliefs and pain intensity and disability was analyzed by means of multiple linear regression models and proportional odds models, reporting odds ratios and 95% confidence intervals. Shoulder and pain disability scores were significantly associated with fear-avoidance beliefs (p < 0.0001, adjusted R-square 0.93, multiple linear regression). There was no evidence of an association between sex and age in this study. The regression coefficient for shoulder pain intensity and disability score was 0.67446. The proportional odds model showed an odds ratio of 1.39 (1.29-1.50) for shoulder pain intensity and disability total score. This study suggests that greater levels of fear-avoidance beliefs are associated with greater levels of shoulder pain and disability in adults with chronic shoulder pain.

Clinical course of pain and function in subacromial shoulder pain: a systematic review with meta-analysis

Objective To assess the clinical course of pain and function in patients with subacromial pain. Design Systematic review. Methods We searched Medline, Embase, AMED, Web of Science, Cochrane Library, and Scopus for randomized clinical trials and observational studies recruiting participants with subacromial pain. Pain and function scores were extracted for groups receiving either ‘no intervention’ or ‘usual care’. Changes in pain and function from baseline were pooled at 6 weeks, 3, 6, and 12 months follow-up. Random effects meta-analyses and meta-regression were performed to assess the clinical course of pain and function in subacromial pain. Results Nineteen studies were included and 17 studies were pooled. Data from 5 studies in the ‘no intervention’ group were pooled to 3 months, showing minimal improvement for pain (mean difference, MD, 5.3/100, 95%CI −0.8 to 11.4) and function (MD 3.1/100, 95%CI −1.7 to 7.9). Data from 12 studies in ‘usual care’ group were pooled to 12 months, showing significant improvement for pain (MD 32.5/100, 95%CI 22.6 to 42.3) and function (MD 30.3/100, 95%CI 24.4 to 36.1), with approximately 40% of this gain in the first 6 weeks. Conclusion With ‘no intervention’, participants with subacromial pain are unlikely to show changes for pain and function within 3 months. For participants receiving ‘usual care’, recovery continued up to 12 months with almost 40% of this change during the first 6 weeks of care. Individuals with subacromial pain who received ‘usual care’ may have moderate changes in terms of minimal clinical important differences up to 12 months. PROSPERO registration number CRD42016052518.

Immediate response to injection is associated with conservative care outcomes at 12 weeks in subacromial shoulder pain

BackgroundSubacromial injection is known to influence pain of subacromial origin, yet its association with conservative care outcomes is unknown. This study investigated whether immediate response to subacromial injection of corticosteroid and local anaesthetic is associated with conservative care outcomes at 12 weeks post injection and/or progression to surgery. Designprospective prognostic cohort study. MethodsSixty-four participants with subacromial related shoulder pain attending initial orthopaedic outpatient appointment at an Australian public hospital, received subacromial injection of corticosteroid and local anaesthetic followed by up to 12 weeks of physiotherapy. Immediate response to injection was measured by change in shoulder range of motion (ROM) and pain immediately (within 20 min) before and after injection. The Shoulder Pain and Disability Index (SPADI) was measured at baseline, 6 and 12-weeks. ResultsBackward stepwise linear regression revealed immediate post-injection improvement in pain-free ROM (p = 0.001) and higher baseline symptoms (p = 0.016) were significantly associated with better 12-week SPADI outcomes. Longer symptom duration (p = 0.029) and higher age (p = 0.013) were significantly associated with poorer outcomes. Only 11 individuals progressed to surgery. The resultant model could explain 35% of the variation in change in SPADI at 12 weeks. ConclusionImprovement in pain-free shoulder ROM immediately post injection is significantly associated with better 12-week conservative care outcomes. This information, derived from within consultation injection responses, could help inform decisions about potential treatment options. Further research with higher numbers and longer-term patient-reported outcomes could further clarify these findings. RegistrationAustralia and New Zealand Clinical Trials Registry 21 May 2012: 12612000532808.

Association between changes in pain or function scores and changes in scapular rotations in patients with subacromial shoulder pain: a prospective cohort study

BackgroundScapular dyskinesis is reported as one of the potential factors contributing to the presentation of pain in subacromial shoulder pain. In clinical practice, the evaluation and control of scapular dyskinesis is considered important for managing the subacromial shoulder pain. The aim is to determine the association between changes in pain or function and changes in scapular rotations in participants with subacromial shoulder pain.MethodPain, function and scapular rotations were measured in 25 participants with subacromial shoulder pain at baseline and after 8 weeks. Pain was measured with Numeric Pain Rating Scale (NPRS) and function was measured with Patient Specific Functional Scale (PSFS). Scapular rotations were measured with a scapular locator at 60°, 90° and 120° of scapular arm elevation. Spearman rank correlations (rs) were used to assess the association between variables.FindingsNo association was observed between changes in pain or function scores with changes in scapular upward/downward rotations (rs = 0.03 to 0.27 for pain and − 0.13 to 0.23 for function) and scapular anterior/posterior tilt (rs = − 0.01 to 0.23 for pain and − 0.13 to 0.08 for function) of arm at 60°, 90° and 120° elevation. Data associated with scapular internal/external rotation was not reported due to low reliability.ConclusionThese findings reject associations between changes in pain or function scores and scapular rotations. Future observational study is warranted using a multifactorial approach to understand potential factors that contribute to the presentation of subacromial shoulder pain.

Ultrasound-Tailored Treatment of Subacromial Shoulder Pain

Background and Objectives: Subacromial shoulder pain is the most common cause of shoulder pain consultation in musculoskeletal practice. Partial supraspinatus tendon tears have frequently been treated using a subacromial corticosteroid injection or surgery. The clinical use of a platelet-rich plasma (PRP) injection is an alternative treatment method for the condition, despite the paucity of evidence of its efficacy. The objective of the study was to assess the clinical effectiveness of autologous PRP in comparison to steroid injection in terms of pain relief and functional restoration in subacromial shoulder pathology. Methodology: All the patients above 18 years of either sex presenting with complaints of shoulder pain and painful abduction and elevation of arm for more than 6 weeks and not received any steroid injection in the previous 6 months were included in the study. In intra-articular PRP (IA-PRP), i.e., test group, 20 patients received 3 ml of single IA PRP injection, and in the steroid group (control group), 20 patients received 1 ml of intra-articular corticosteroid (IA CS) into glenohumeral joint under ultrasound (US) guidance. All patients were prospectively followed for 6 months. Results: There were no differences in visual analog scale (VAS) and disability scores between the PRP and corticosteroid groups at 1-month follow-up. However, the PRP group had better scores than the corticosteroid group on both the VAS and disability scores at 3- and 6-month follow-up. The VAS and disability scores did not change significantly at 6-month follow-up in the corticosteroid group; however, the PRP group showed continued improvement in both VAS and disability scores between 1- and 6-month follow-up. The PRP group had better scores than the corticosteroid group on shoulder range of motion after postintervention follow-up after 1 month. There were no complications in either group. Conclusion: Both subacromial PRP and corticosteroid injections had a positive clinical response in the treatment of shoulder pain. In view of the reached results, it may be assumed that steroid injections may provide symptomatic relief but not promote healing which makes PRP injection a good alternative as it is simple, easy to use, easily available, prepared from patient's own blood, and cost-effective. US-guided injections may increase the efficacy of accurately targeted injections.

Subacromial bursitis and shoulder pain: Exploring the predictors for a negative anaesthetic response

Subacromial bursitis and shoulder pain: Exploring the predictors for a negative anaesthetic response

Three-dimensional kinematic analysis of upper limb movements between individuals with and without subacromial shoulder pain exploring the statistical parametric mapping

Subacromial shoulder pain (SSP) accounts for 44–65% of all cases of shoulder pain. Kinematic alterations in the upper limbs have been observed in individuals with SSP, although there is no consensus on such alterations in the literature. Therefore, the present study aimed to compare the three-dimensional kinematics of the scapula, trunk, and arm during shoulder flexion-extension and abduction-adduction movements in individuals with SSP and a control group using statistical parametric mapping (SPM). We evaluated 117 participants [61 with SSP and 56 in the control group (CG)]. The three-dimensional kinematic analysis was performed starting from arm extension/adduction (0%), moving to flexion/abduction, and ending returning to extension/adduction, respectively (100%) in both groups. SSP group flexed more their trunk (0–100%, p < 0.001) and rotated scapula internally (0–20%, p < 0.001 and 75–100%, p < 0.001); rotated upwards (17–32%, p < 0.005 and 58–87%, p < 0.003) and posteriorly tilted (28–79%,p < 0.001 and 81–95%,p < 0.006) less than CG group during arm abduction-adduction. Through arm flexion-extension, the SSP group flexed (38–82% p < 0.009) less their trunk, rotated upwards (5–10% p = 0.021) less their scapula, and posteriorly tilted scapula (0–100% p < 0.001) more than CG. Combining conventional variables used to describe motion in individuals with SSP, such as minimum and maximum values, range of motion, and results provided by SPM can furnish a detailed description of the compensations and limitations of the patient, enabling a better understanding of the function of the scapular girdle as well as improvements in the evaluation process and clinical decision making.

Influence of Nonoperative Treatments for Subacromial Shoulder Pain: A Review Article

Sub-acromial pain syndrome (SAPS) in overhead athletes is the most common reason for shoulder pain. As a rational decision, the medical treatments of today will likely be the best cure for this particular population. Conservative techniques are generally utilised to treat inflammation and pain through electrophysical approaches or to control the subacromial space to avoid impingement by rotator cuff and scapular muscle exercises, as the SAPS (subacromial pressure) mechanism remains unclear. The aim of this analysis is to assess the efficiency of these measures for pain reduction and function improvement. The literature, the best research source to be used, was searched using such search engines as PubMed, Medline, and Google Scholar. The articles were chosen in a manner that relates to the study objective and also their scientific relevance. This research may inform that in subjects with a reduced subacromial space, exercise can have a greater impact on overhead athletes. The effectiveness of centred therapy with Extracorporeal Shockwave (ESWT) on severe plantar fasciitis is uncertain. A greater cohort with its training efficiency in comparison with the conventional physiotherapy programme is required to demonstrate the efficacy of SAPS bodyblade exercise on overhead athletes.

Ultrasound Diagnosed Disorders of Subacromial Shoulder Pain Patients: A Retrospective Study at a Tertiary Care Rural Hospital, Mewat, Haryana

Introduction: Shoulder pain is leading cause of disability and pain among musculoskeletal pain patients. Ultrasound is coming in a bigger way for diagnosis and management of subacromial pain due to its low cost, easy availability and accuracy in detecting soft tissues pathologies and for planning further treatment. Aim: To assess the role of diagnostic Ultrasound (US) in subacromial shoulder pathologies evaluation in shoulder pain patients. Materials and Methods: This was a retrospective observational study conducted on 98 patients who presented with subacromial shoulder pain. Diagnostic ultrasound examination was done and patients were categorised based upon underlying pathology and analysed in terms of frequency. Results: Most common ultrasound findings in subacromial shoulder pain patients were subacromial bursopathy 46 (46.93%) followed by Rotator cuff pathology including tear 38 (38.77%), mixed pathology 9 (9.18%) and Acromioclavicular (AC) joint pathology 5 (5.10%). Isolated biceps pathology was not seen in our study rather biceps pathology along with other tendon and joint involvement was observed. Conclusion: The findings in the present study imply that diagnostic ultrasound of shoulder pain patients helps to stratify them into different categories for better understanding of underlying pathology and targeted treatment approach. Ultrasound shall be used as an outpatient primary diagnostic modality for evaluation of subacromial shoulder pain patients.

Patients with shoulder pain referred to specialist care; treatment, predictors of pain and disability, emotional distress, main symptoms and sick-leave: a cohort study with a six-months follow-up.

Objectives Recommendations for referral of patients with shoulder pain from primary to specialist care are mainly clinical. Several patients are referred without meeting these criteria for referral, whereas some are referred for a second opinion although surgery is not recommended. The aims of this study were to describe a shoulder pain cohort in specialist healthcare according to demographic data, clinical, and psychological factors; evaluate changes in pain and disability, distress and main symptoms from baseline to six-month follow-up; and to assess predictors of pain and disability, changes in the main symptoms and sick-leave at six-months. Results were compared to previous randomised trials conducted at the same clinic in patients with subacromial shoulder pain. Methods This prospective study included 167 patients from an outpatient clinic in specialist healthcare with shoulder pain for more than 6weeks. Clinical (pain duration, intensity, pain sites), sociodemographic (age, gender, educational level, work status) and psychological variables (emotional distress (HSCL-10), fear of pain, screening of "yellow flags", health-related quality of life) were collected. Shoulder pain and disability (SPADI-score) were assessed and the patients were asked about their outcome expectation and to predict their status of their shoulder problem the next month. They underwent a clinical interview, a clinical assessment of shoulder function and orthopaedic tests for diagnostic purposes. After six months they received a questionnaire with main variables. Results Of the 167 patients (55% women), 50% had symptoms for more than 12months and 37 (22%) were on sick-leave. Characteristics were in general comparable to patients previously included in clinical trials at the same department. The SPADI-score was 46 (23) points. Mean emotional distress was within the normal range (1.7 (SD 0.6)). More than 80% had received treatment before, mainly physiotherapy in addition to the GPs treatment. One hundred and thirty-seven patients (82%) were re-referred to physiotherapy, 74 (44%) in the outpatient clinic specialist healthcare, and 63 (38%) in primary care. One hundred and eighteen (71%) answered the follow-up questionnaire. Mean change in SPADI-score was 10.5 points (95% CI (6.5-14.5)), and 29% of the patients improved more than the smallest detectable difference (SDD). The percentage sick-listed was 19.5%, and mean change in main symptoms (-9 to+9) was 3.4 (SD 3.9). The subgroup of patients receiving physiotherapy in outpatient specialist care did not show any significant change in the main variables. The prediction models suggested that a lower level of education, more fear of pain and a high baseline SPADI-score, predicted a higher SPADI-score at follow-up. A high baseline HSCL-10 score was the only significant predictor for a high HSCL-10 score. At follow-up, less pain at rest predicted more change in main symptoms and more yellow flags (a higher score on the Örebro screening test) predicted sick-leave. Conclusions Within the limitations of a cohort study, patients with persistent shoulder pain referred to an outpatient specialist clinic had similar baseline characteristics but shorter treatment duration, inferior clinical results and predictors somewhat different compared with previous clinical trials conducted at the same clinic. The study raises some questions about the effectiveness of the routines in daily clinical practice, the selection of patients, the treatment duration and content.

Kinesiophobia Is Associated With Pain Intensity and Disability in Chronic Shoulder Pain: A Cross-Sectional Study

ObjectiveKinesiophobia is a clinically relevant factor in the management of chronic musculoskeletal pain. The aim of this study was to explore the cross-sectional association between kinesiophobia and both pain intensity and disability among individuals with chronic shoulder pain. MethodsA total of 65 participants with chronic unilateral subacromial shoulder pain were recruited from 3 primary care centers. The Shoulder Pain and Disability Index assessed pain intensity and disability. The Tampa Scale for Kinesiophobia short form assessed the presence of kinesiophobia. A linear multivariable regression analysis evaluated the potential association between kinesiophobia and range of movement free of pain with pain intensity and disability. The analysis was adjusted for sex and age. ResultsIn the linear multivariable regression analysis, only greater kinesiophobia (standardized β = 0.35, P < .01) and sex (standardized β = -0.29, P < .01) contributed to explain 19% of the variance in shoulder pain and disability scores. ConclusionThis cross-sectional study provides preliminary evidence about the association between kinesiophobia and pain intensity and disability among individuals with chronic shoulder pain. However, our findings only contributed to explain 19% of the variance in shoulder pain and disability scores.

Seven Key Themes in Physical Therapy Advice for Patients Living With Subacromial Shoulder Pain: A Scoping Review.

To systematically scope the reported advice and education in physical therapy management of patients with subacromial shoulder pain, and to define key themes of the advice and education. Scoping review. We searched MEDLINE, Scopus, Web of Science, and CINAHL, with publication dates from 2007 to September 2019. We included quantitative and qualitative research that reported on physical therapy interventions for subacromial shoulder pain. We performed a qualitative synthesis that identified items included in patient advice and education. Of 89 original studies included, there were 61 randomized controlled trials; 5 prospective studies; 16 nonrandomized observational intervention studies or case series; and 7 surveys, audits of physical therapy patient records, and focus groups with physical therapists. We identified 7 key themes for advice and education: exercise intensity and pain response, activity modification advice, posture advice, pain self-management advice, pathoanatomical and diagnosis information, behavioral approaches, and pain biology advice. While advice focused predominantly on the local tissue pathology model, 10% of studies included information about pain neuroscience education, psychosocial factors, motor imagery, or behavior change. J Orthop Sports Phys Ther 2020;50(6):285-293. doi:10.2519/jospt.2020.9152.

Is there an association between changes in pain or function with changes in scapular dyskinesis: A prospective cohort study

ObjectiveTo assess the association between changes in pain or function with changes in scapular dyskinesis in participants with subacromial shoulder pain. MethodForty-four participants with subacromial shoulder pain were assessed at baseline and 8 weeks later. The outcome measures included ‘pain at rest’ and ‘pain during movement’ using Numeric Pain Rating Scale (NPRS), shoulder function using Patient Specific Functional Scale (PSFS), and observation of scapular movement pattern using the scapular dyskinesis test. Robust paired t-tests were used to compare scores between baseline and follow-up. Repeated measures correlation coefficient was used to assess the association between changes in pain or function with changes in scapular dyskinesis scores. ResultsA fair association was found between improvement in function and improvement in scapular dyskinesis (correlation coefficient = −0.4, 95% CI: −0.6 to −0.1). No associations were found between changes in ‘pain at rest’ (correlation coefficient = −0.1, 95% CI: −0.2 to 0.2) or ‘pain during movement’ (correlation coefficient = 0.28, 95% CI: 0.0 to 0.5) with changes in scapular dyskinesis. ConclusionOur findings showed improvement in function is associated with improvement in scapular dyskinesis scores. Future studies should explore whether there is causal effect between improvement in scapular dyskinesis and function.

Effects of a Traditional versus an Alternative Strengthening Exercise Program on Shoulder Pain, Function and Physical Performance in Individuals with Subacromial Shoulder Pain: A Randomized Controlled Trial.

A manual shoulder-training device may represent an alternative training device to improve symptoms and function in patients with subacromial shoulder pain by strengthening the external rotators. Thus, we examined the effects of a traditional versus an alternative strengthening exercise program on shoulder pain/function and physical performance in individuals with subacromial shoulder pain. Fifty-six adults with subacromial shoulder pain were randomly assigned to a passive control group (CON; n = 20), a traditional training group (TRA; n = 19), or an alternative training group (ALT; n = 17). Both training groups conducted a progressive home-based strengthening exercise program for the external rotators for eight weeks using elastic bands only (TRA group) or in combination with the shoulder-training device (Schulterhilfe®) (ALT group). Pre- and post-training assessment included measures of shoulder pain/function (i.e., shoulder pain and disability index (SPADI)) and physical performance (i.e., shoulder flexibility, maximal isometric strength, and strength endurance). We found significant test × group interactions in most of the investigated variables. Post hoc analyses showed significant training-related improvements for proxies of shoulder pain/function, shoulder flexibility, maximal isometric strength, and strength endurance in favor of the ALT and TRA group in comparison to the CON group. Further, larger and more frequent effects were found for the ALT compared to the TRA group. Measures of shoulder pain/function and physical performance can be significantly improved by both training regimens in individuals with subacromial shoulder pain. However, strength training using elastic bands with the manual shoulder device (ALT group) as compared to elastic bands (TRA group) only was more effective and may thus be a recommendable alternative in order to mitigate subacromial shoulder pain.

Painful Shoulder: Exercise Can Reduce Pain and Improve Mobility and Function.

Shoulder pain is common, especially as we age. Pain that limits your ability to raise your arm above your head or rotate your shoulder is called "subacromial shoulder pain." The good news is that most people with subacromial shoulder pain improve with physical therapy. A review of the most up-to-date research published in the March 2020 issue of JOSPT concluded that shoulder exercises are the best way to manage this pain. J Orthop Sports Phys Ther 2020;50(3):142. doi:10.2519/jospt.2020.0501.