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

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.

Evaluation of acromion morphology and subacromial distance in patients with shoulder pain

“…Petersson and Redlund-Johnell [10] and Jost et al [8] stated that an acromiohumeral distance of ≤ 7 mm measured on anteroposterior radiographs triggered significant damage to the rotator cuff muscles and reduced the likelihood of successful surgery. Park et al [38] found a significant difference between VAS and subacromial distance values in the study they conducted in the general population aged 29-74 whose pain persisted for > 3 months. In our study, similar to the literature, 7 mm was set as the critical value for the subacromial distance and identified the changes above and below this threshold.…”

Influence of rigid taping on the acromiohumeral distance in healthy recreational weightlifters

“…As previously mentioned, treatment of a patient with subacromial pain syndrome should not only focus on addressing a possible decrease in the AHD, but also on the importance of other biopsychosocial factors ( Park et al, 2020 ). Nevertheless, according to the authors the evidence is still limited to determine the correlation between AHD and pain or disability, as the included studies had different outcome measures and different study population ( Park et al, 2020 ). The differences in the AHD found in our study justify the use of this technique to obtain an increase in the distance in healthy subjects.…”

“…Conservative treatment is the first approach to the subacromial pain syndrome, with shoulder taping as one of the most used techniques ( Zanella et al, 2001 ; Cools et al, 2002 ; Selkowitz et al, 2007 ; Thelen, Dauber & Stoneman, 2008 ). A recent review has studied the relationship between the AHD and the existence of symptoms such as pain and disability, suggesting the importance of also addressing other biopsychosocial factors when dealing with a symptomatic patient ( Park et al, 2020 ). There are many different studies where taping is applied to modify shoulder articular properties ( i.e., shoulder’s kinematics, muscle force, range of motion, neuromuscular control, pain or joint stability) ( Host, 1995 ; Ackermann, Adams & Marshall, 2002 ; Lewis, Wright & Green, 2005 ; Thelen, Dauber & Stoneman, 2008 ; Shaheen et al, 2013 ; Harput et al, 2017 ), some of them also demonstrating the effectiveness of the taping to increase the AHD ( Luque-Suarez et al, 2013 ; Lyman et al, 2017 ; Bdaiwi et al, 2017 ; Harput et al, 2017 ).…”

Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer with Subacromial Pain (Impingement) Syndrome

“…The main factor in the development of a swimmer's shoulder seems to be the high training volume during growth in the absence of a balanced dryland training program (Porter et al, 2020). Most swimming strokes consist of a pull-through phase that generates speed and a recovery phase where the arm is over the water (Bak, 2010).…”