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Terminology and diagnostic criteria used in studies investigating patients with subacromial pain syndrome from 1972 to 2019: a scoping review
  1. Adam Witten1,
  2. Karen Mikkelsen1,
  3. Thomas Wagenblast Mayntzhusen1,
  4. Mikkel Bek Clausen2,
  5. Kristian Thorborg1,
  6. Per Hölmich1,
  7. Kristoffer Weisskirchner Barfod1
  1. 1 Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  2. 2 Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Adam Witten, Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager-Hvidovre, 2650 Hvidovre, Denmark; wittenadam{at}


Introduction There is no recognised terminology, nor diagnostic criteria, for patients with subacromial pain syndrome (SAPS). This is likely to cause heterogeneity across patient populations. This could be a driver of misconceptions and misinterpretations of scientific results. We aimed to map the literature regarding terminology and diagnostic criteria used in studies investigating SAPS.

Materials and methods Electronic databases were searched from inception to June 2020. Original peer-reviewed studies investigating SAPS (also known as subacromial impingement or rotator cuff tendinopathy/impingement/syndrome) were eligible for inclusion. Studies containing secondary analyses, reviews, pilot studies and studies with less than 10 participants were excluded.

Results 11 056 records were identified. 902 were retrieved for full-text screening. 535 were included. 27 unique terms were identified. Mechanistic terms containing ‘impingement’ are used less than before, while SAPS is used increasingly. For diagnoses, combinations of Hawkin’s, Neer’s, Jobe’s, painful arc, injection test and isometric shoulder strength tests were the most often used, though this varied considerably across studies. 146 different test combinations were identified. 9% of the studies included patients with full-thickness supraspinatus tears and 46% did not.

Conclusion The terminology varied considerably across studies and time. The diagnostic criteria were often based on a cluster of physical examination tests. Imaging was primarily used to exclude other pathologies but was not used consistently. Patients with full-thickness supraspinatus tears were most often excluded. In summary, studies investigating SAPS are heterogeneous to an extent that makes it difficult, and often impossible, to compare studies.

  • Shoulder
  • Arthroscopy
  • Rotator cuff
  • Sports medicine
  • Tendinopathy

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  • Contributors AW, MBC, KT, PH and KWB conceptualised and designed the study. AW, KM and TWM designed the data collection instruments and collected data. AW and KWB drafted the initial manuscript. All authors contributed to the final manuscript. AW is responsible for the integrity of the work as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.