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

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

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.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow chart of included studies. From the nine studies included in the first aim, one study was also included in the second aim. Similarly, two studies were also included for the third aim.
Figure 2
Figure 2
Forest plots comparing AHD (mm) in participants with SAPS and controls with no shoulder pain in varying degrees of shoulder abduction; (A) 0°, (B) 45°, (C) 60°.
Figure 3
Figure 3
Meta-analysis results comparing occupation ratio percentage in participants with SAPS and controls with no shoulder pain at 0° of shoulder abduction. OcR: Occupation ratio percentage.

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