Update of guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopedic Association
Dutch Orthopaedic Association · 2026 · Europe
Source and licence
- Authors
- Frederik O LAMBERS HEERSPINK, Egbert J D VEEN, Oscar DORRESTIJN et al.
- Title
- Update of guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopedic Association
- Journal
- Acta Orthopaedica, 2026
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC12908218
Licence statement of the original publication
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/)
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Clinical question 2: What is the diagnostic accuracy for using a combination of multiple tests compared with a single test in diagnosing or ruling out SAPS?
- Recommendations• Performing a cluster of physical diagnostic tests slightly improves diagnostic accuracy for SAPS compared with a single test. During physical examination, multiple tests should be performed to rule out other pathologies such as rotator cuff tears, labral tears, and biceps tendon pathology, as these may require different treatment approaches.
Clinical question 3: What is the value of ultrasonography vs MRI in patients suspected of having a partial thickness tear in the supraspinatus tendon?
- Recommendation• Perform ultrasonography in patients with clinical suspicion of full-thickness or partial-thickness rupture of the supraspinatus tendon to guide treatment decisions.
Clinical question 4: What is the effectiveness of barbotage compared with shockwave therapy in patients with calcifying tendinitis on patient-reported outcome measures?
- Recommendations• Start treatment with corticosteroid injections in the subacromial bursa. • Consider barbotage for symptomatic calcific tendinosis with corticosteroid injection in the bursa, acknowledging that recent evidence suggests limited additional benefit over corticosteroid injection alone. Barbotage may be most beneficial in selected patients with large calcifications who have failed initial corticosteroid injection.
Clinical question 5: What are the benefits and harms of subacromial corticosteroid injection in addition to exercise in patients with subacromial shoulder complaints?
- Recommendation• Consider a subacromial corticosteroid injection (with a local anesthetic) to enable exercise therapy in patients with severe complaints that impair their ability to participate in exercise therapy.
Clinical question 6: What is the effectiveness of suprascapular nerve block (SSNB) vs corticosteroid injection in SAPS patients on patient-reported outcome measures?
- Recommendations• Consider SSNB for patients with therapy-resistant SAPS when other non-surgical treatment is ineffective.
Abstract
Background and purpose: In 2013, the first clinical practice guideline for subacromial pain syndrome (SAPS) was developed in the Netherlands to support healthcare professionals. SAPS refers to non-traumatic, non-rheumatologic shoulder complaints that are particularly painful during arm elevation. It includes conditions such as supraspinatus tendinosis, calcific tendinitis, and degenerative supraspinatus tears. Over 50,000 patients annually consult orthopedic surgeons for these issues. In response to new evidence and clinical needs, an updated guideline was developed. Part 1 addresses prevention, diagnosis, imaging, and non-surgical treatment. Using a multidisciplinary, evidence-based approach, the guideline aims to answer key clinical questions around SAPS.
Methods: Initiated by the Dutch Orthopedic Society, the guideline committee identified knowledge gaps through group sessions. Each module was based on a PICO-formatted key question and reviewed by professionals from different fields. The AGREE and GRADE methods were applied to ensure a systematic evaluation of evidence, leading to conclusions and recommendations.
Results: (i) Inform patients about the potential positive effects of a healthy lifestyle and encourage gradual exercise within sport and work. (ii) Perform a cluster of physical diagnostic tests to diagnose SAPS. (iii) Perform ultrasonography in patients with clinical suspicion of (partial thickness) rupture of the supraspinatus tendon. Consider MRI if ultrasound is not available or inconclusive. (iv) Consider barbotage for symptomatic calcific tendinosis, preferably with corticosteroid injection in the bursa, if a previous corticosteroid injection was ineffective. (v) Consider a subacromial corticosteroid injection (with a local anesthetic) to enable exercise therapy in patients with severe complaints that impair their ability to participate in exercise therapy. (vi) Consider suprascapular nerve block for patients with therapy-resistant SAPS when other non-surgical treatment is ineffective.
Conclusion: The updated guideline provides multidisciplinary recommendations for physical examination, imaging, and conservative management of SAPS.
Contents of the original publication
The section headings of the original.
- Methods
- Terminology
- Guideline working group formation and the formulation of scoping questions
- Guideline methodology
- From evidence to recommendation
- Consensus process
- Results
- Scoping question 1: What preventive measures can be used in the working population to prevent recurrent SAPS?
- Clinical question 2: What is the diagnostic accuracy for using a combination of multiple tests compared with a single test in diagnosing or ruling out SAPS?
- Clinical question 3: What is the value of ultrasonography vs MRI in patients suspected of having a partial thickness tear in the supraspinatus tendon?
- Clinical question 4: What is the effectiveness of barbotage compared with shockwave therapy in patients with calcifying tendinitis on patient-reported outcome measures?
- Clinical question 5: What are the benefits and harms of subacromial corticosteroid injection in addition to exercise in patients with subacromial shoulder complaints?
- Clinical question 6: What is the effectiveness of suprascapular nerve block (SSNB) vs corticosteroid injection in SAPS patients on patient-reported outcome measures?
- Discussion
- Lifestyle
- Non-surgical therapy
- Physical examination
- Ultrasonography vs MRI
- Barbotage
- Supplementary data
A question about this guideline?
Medelix answers clinical questions from guidelines and studies – every statement with its source.
Are you the rights holder and object to this reproduction? Write to contact@medelix.ai and we will take the page down promptly. Imprint