Summary

Treatment of “subacromial impingement syndrome” of the shoulder has changed drastically in the past decade The anatomical explanation as “impingement” of the rotator cuff is not sufficient to cover the pathology. “Subacromial pain syndrome”, SAPS, describes the condition better.There is no convincing evidence that surgical treatment for SAPS is more effective than non-operative management.

Abstract

A working group formed from a number of Dutch specialist societies, led by the Dutch Orthopedic Association, has produced a statement based on the available scientific evidence. This resulted in a new guideline for the diagnosis and 6 treatment of subacromial pain syndrome. The important advices on treatment and diagnosis were:
Ultrasound examination is the recommended primary imaging. There is no convincing evidence that surgical treatment for SAPS is more effective than non-operative management. ergo SAPS should preferably be treated non-operatively. Acute pain should be treated with analgetics , Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms. Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance . Occupational interventions are useful when complaints persist for longer than 6 weeks.Rehabilitation in a specialized unit can be considered in chronic, treatment-resistant SAPS, with pain-perpetuating behavior
.We measured the effect on practice behaviour since the publication of this study, In a number of clinics, the number of surgeries for subacromial "impingement" syndrome , diminished with > 50% in 2 years, allthough in other hospitals the number did not change. Theories involving effects on states of change and on barriers to change practice habits should be used to de-implement professional habits and patients wishes.