Subacromial Pain Syndrome

Subacromial Pain Syndrome (SPS) is a condition characterized by pain, limited motion, and tenderness in the subacromial space of the shoulder joint. It is also known as rotator cuff disease, rotator cuff tendinosis, and shoulder impingement syndrome (SIS), short for shoulder impingement syndrome, which describes the pinching of the rotator cuff tendons and bursa between bones in the subacromial space.

SPS may also manifest as calcifying tendinitis of the shoulder, causing additional shoulder pain. Rotator cuff tendonitis and shoulder bursitis, both inflammation of the subacromial space, are often confused but share similar symptoms. In severe cases, SIS involves both inflammation of the rotator cuff tendons (tendonitis) and the adjacent bursa (bursitis). Often, the subacromial space is reduced in size due to bone shape variations compared to healthy individuals.

SIS is the most common form of shoulder pain. Repetitive shoulder movements during work or sports, such as swimming, throwing, tennis, weightlifting, golf, volleyball, and gymnastics, are the primary risk factors for developing SIS. Age is also a contributing factor to the development of SIS.

The primary symptoms of SPS include widespread shoulder pain, limited range of motion, and significant tenderness in the affected area.

PerVitaShockNavi™

Treatment Position
The patient is positioned in a sitting or prone position. During treatment, the affected limb is instructed to hang naturally to widen the subacromial space, and the probe is directed at the subacromial space for shocking wave therapy.

  • PerVitaShockNavi™

Treatment Position
The patient is positioned in a sitting or prone position. During treatment, the affected limb is instructed to hang naturally to widen the subacromial space, and the probe is directed at the subacromial space for shocking wave therapy.

Localization Method
The localization method combines anatomical landmarks on the body surface with tender point localization, or ultrasound can also be used for localization.

Treatment Parameters
Three impact points are selected: the lateral side of the coracoid process anterior to the acromion, the anterior angle of the acromion, and the lateral side of the acromion (some patients may require an additional posterior angle of the acromion). Each point is treated with 1000 impulses, with low to medium energy flux density. Treatments are spaced 7 days apart, and a course of treatment consists of 3 to 5 sessions (Parameters based on clinical practice guidelines in shockwave therapy for musculoskeletal disorders).

Treatment Outcome
ESWT for Subacromial Pain Syndrome (SPS) has substantial success rates, with studies by NIH and NHS reporting rates of 60%-85%, comparable to tennis elbow treatment but tailored to SPS (NIH, NHS). The FDA approved low- and high-energy shock wave generators in 2002 and 2003 for musculoskeletal conditions, including SPS. ESWT alleviates pain and improves outcomes through tissue regeneration, pain modulation, and inflammation reduction. However, patient responses vary, so outcomes should be assessed individually. Consultation with a healthcare provider is recommended for personalized recommendations and risk-benefit discussion.

Treatment Steps

Clinical Diagnosis
Conditions I Disease Duration I Exclude Contraindications
Locate Pain Points
Palpation I X-ray I Ultrasound I MRI I Anatomical Landmarks
Set Parameters
Patient Positioning I Energy I Pressure I Frequency I Number of Treatments
SWT TREATMENT
Apply Coupling Agent on Treatment Area I Assess Pain Tolerance
Clean Up End
Remove Coupling Agent I Probe Alcohol Disinfection

Treatment Techniques

  • Rotation/Semi-Static Technique
    Performed at tender points and trigger points, generally not exceeding 1,500 impulses.
  • Application/Dynamic Technique
    Around the tender points or surrounding soft tissue, approximately 500 impulses.

Contraindications：

①. Patients with hemorrhagic disorders or coagulation dysfunction;
②. Local and adjacent areas with thrombosis;
③. Patients with severe cognitive impairments or mental illnesses;
④. Local areas with pacemakers;
⑤. Local areas with tumors;
⑥. Lower abdominal region of pregnant women;
⑦. Patients with ruptured or severely injured tendons and fasciae, as well as areas with the brain, spinal cord, large blood vessels, and critical nerve trunks;
⑧. Abdominal organs (especially lung tissue);
⑨. Patients with bone defects greater than 2 centimeters;
⑩. Patients with joint fluid leakage;
⑪. Pediatric patients with growing pains

* Conditions deemed unsuitable by physicians.

Adverse Reactions:

① Local hematoma, ecchymosis, and petechiae at the treatment site;
② Temporary intensification of pain at the treatment site within a short period;
③ Local numbness, needle sensation, and hypoesthesia at the treatment site;
④ High-energy extracorporeal shockwave therapy may cause local nerve and vascular damage;

* These adverse reactions generally resolve within 1 week and do not require special treatment.

Disclaimer: Content Related to PerVitaShockNavi™ Operational Guidelines

The content related to the PerVitaShockNavi™ Operational Guidelines is solely for reference purposes. Specific operations should be carried out under the guidance and supervision of a professional doctor. Users are advised to consult with a healthcare professional before using any of the procedures or treatments outlined in these guidelines. By accessing and using this information, you acknowledge and agree to hold harmless the providers of this information from any liability arising from the use or misuse of the guidelines.