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 · PMC12908219
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 1: What is the effectivity of cuff repair compared with physiotherapy with or without corticosteroid injection on patient-reported outcome measures in adult patients (< 70 years) with an isolated symptomatic, nontraumatic supraspinatus tear?
- Recommendations• For patients with an isolated, symptomatic, non-traumatic supraspinatus tendon tear, start with non-surgical therapy, such as exercise therapy, potentially combined with a corticosteroid injection. • Consider surgical treatment if non-surgical therapy is not effective after 3–6 months.
Clinical question 2: What are the effects of tenotomy or tenodesis of the LHBT in patients with an isolated supraspinatus tendon tear and no LHBT pathology?
- Recommendations• Exercise caution when performing biceps tenotomy or tenodesis on a normal-looking LHBT during a supraspinatus tendon repair, because there is a risk of damaging the LHBT as a result of the repair.
Clinical question 3: What are the prognostic factors for success or failure after rotator cuff repair?
- Recommendation• Assess both patient- and cuff tear-related factors to estimate the success rate of rotator cuff repair. • Consider performing MRI investigation of the shoulder for a more detailed evaluation of cuff tear-related factors.
Clinical question 4: What is the effectiveness of early mobilization supported by a sling up to a maximum of 3 weeks vs long-term (6 weeks) immobilization with a sling in patients where the supraspinatus tendon is repaired?
- Recommendation• Consider starting early mobilization with a maximum of 3 weeks’ immobilization in patients following surgical repair of an isolated supraspinatus tendon tear.
Clinical question 5: What is the effectiveness of surgical calcium removal compared with barbotage on patient-reported outcome measures in adult patients with calcifying tendinitis of the supra- or infraspinatus?
- Recommendation• Start with conservative treatment for symptomatic calcifying tendinitis, given its self-limiting nature. • Consider barbotage if conservative treatment fails, acknowledging limited evidence for additional benefit over corticosteroid injection alone. • Reserve arthroscopic treatment for cases with persistent, disabling symptoms and large calcifications after failed conservative treatment, including barbotage.
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 2 focuses on supraspinatus tears, biceps tendon pathology, and calcific tendinosis. 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) Start with exercise-based therapy (with corticosteroid injection) for isolated, symptomatic, non-traumatic supraspinatus tears. Consider cuff repair if no improvement after 3–6 months. (ii) Avoid biceps tenotomy/tenodesis on a healthy tendon unless at risk during cuff repair. (iii) Evaluate patient- and tear-specific factors; use MRI for detailed assessment. (iv) Consider barbotage for calcific tendinosis; repeat once if needed. Reserve surgery for persistent large calcifications. (v) Postoperative immobilization should not exceed 3 weeks.
Conclusion: The updated guideline provides multidisciplinary recommendations for surgical management.
Contents of the original publication
The section headings of the original.
- Methods
- Terminology
- Results
- Clinical question 1: What is the effectivity of cuff repair compared with physiotherapy with or without corticosteroid injection on patient-reported outcome measures in adult patients (< 70 years) with an isolated symptomatic, nontraumatic supraspinatus tear?
- Clinical question 2: What are the effects of tenotomy or tenodesis of the LHBT in patients with an isolated supraspinatus tendon tear and no LHBT pathology?
- Clinical question 3: What are the prognostic factors for success or failure after rotator cuff repair?
- Clinical question 4: What is the effectiveness of early mobilization supported by a sling up to a maximum of 3 weeks vs long-term (6 weeks) immobilization with a sling in patients where the supraspinatus tendon is repaired?
- Clinical question 5: What is the effectiveness of surgical calcium removal compared with barbotage on patient-reported outcome measures in adult patients with calcifying tendinitis of the supra- or infraspinatus?
- Discussion
- Surgical vs non-surgical treatment of rotator cuff tears
- Prognostic factors for surgical decision-making
- Long head biceps tendon management in rotator cuff repair
- Postoperative rehabilitation
- Calcific deposit removal: surgical vs conservative approach
- Perspectives
- Supplementary data
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