{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:52:29Z","timestamp":1787025149584,"version":"build-2736575974"},"reference-count":34,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0In 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:\u00a0Initiated 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:\u00a0(i) Start with exercise-based therapy (with corticosteroid injection) for isolated, symptomatic, non-traumatic supraspinatus tears. Consider cuff repair if no improvement after 3\u20136 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:\u00a0The updated guideline provides multidisciplinary recommendations for surgical management.<\/jats:p>","DOI":"10.2340\/17453674.2026.45410","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T13:31:39Z","timestamp":1771248699000},"source":"Crossref","is-referenced-by-count":2,"title":["Update of guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopedic Association Part 2: Operative considerations and treatment of various conditions related to subacromial pain syndrome"],"prefix":"10.2340","volume":"97","author":[{"given":"Frederik O","family":"Lambers Heerspink","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6250-4293","authenticated-orcid":false,"given":"Egbert J D","family":"Veen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Dorrestijn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis P J","family":"Visser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten J C","family":"Leijs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Van Poppel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A","family":"Stroomberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon P G","family":"Ottenheijm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan W","family":"Kallewaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjerk J W","family":"De Ruiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henk A","family":"Martens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Femke M","family":"Janssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa","family":"Geltink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs S","family":"Ruiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos J A M","family":"Van Raaij","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"141906","doi-asserted-by":"crossref","unstructured":"Lambers Heerspink F O, Veen E J D, Dorrestein O, Visser C P J, Leijs M J C, van Poppel D et al. Update of guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopedic Association. Part 1: preventive measures, diagnostics and non-surgical treatment of subacromial pain syndrome. Acta Orthop 2026; 97: 91-8. doi: 10.2340\/17453674.2026.45365","DOI":"10.2340\/17453674.2026.45365"},{"key":"141907","doi-asserted-by":"crossref","unstructured":"L\u00e4hdeoja T, Karjalainen T, Jokihaara J, Salamh P, Kavaja L, Agarwal A, et al. Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis. Br J Sports Med 2020; 54(11): 665-73. doi: 10.1136\/bjsports-2018-100486.","DOI":"10.1136\/bjsports-2018-100486"},{"key":"141908","doi-asserted-by":"crossref","unstructured":"Paavola M, Kanto K, Ranstam J, Malmivaara A, Inkinen J, Kalske J, et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial. Br J Sports Med 2021; 55(2): 99-107. doi: 10.1136\/bjsports-2020-102216.","DOI":"10.1136\/bjsports-2020-102216"},{"key":"141909","doi-asserted-by":"crossref","unstructured":"Beard D J, Rees J L, Cook J A, Rombach I, Cooper C, Merritt N, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet 2018; 391(10118): 329-38. doi: 10.1016\/s0140-6736(17)32457-1.","DOI":"10.1016\/S0140-6736(17)32457-1"},{"key":"141910","doi-asserted-by":"crossref","unstructured":"Ghasemi S A, McCahon J A S, Yoo J C, Toussaint B, McFarland E G, Bartolozzi A R, et al. Subscapularis tear classification implications regarding treatment and outcomes: consensus decision-making. JSES Rev Rep Tech 2023; 3(2): 201-8. doi: 10.1016\/j.xrrt.2022.12.004.","DOI":"10.1016\/j.xrrt.2022.12.004"},{"key":"141911","doi-asserted-by":"crossref","unstructured":"Cederqvist S, Flinkkil\u00e4 T, Sormaala M, Ylinen J, Kautiainen H, Irmola T, et al. Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation. Ann Rheum Dis 2021; 80(6): 796-802. doi: 10.1136\/annrheumdis-2020-219099.","DOI":"10.1136\/annrheumdis-2020-219099"},{"key":"141912","doi-asserted-by":"crossref","unstructured":"Kukkonen J, Joukainen A, Lehtinen J, Mattila K T, Tuominen E K, Kauko T, et al. Treatment of non-traumatic rotator cuff tears: a randomised controlled trial with one-year clinical results. Bone Joint J 2014; 96-b(1): 75-81. doi: 10.1302\/0301-620x.96b1.32168.","DOI":"10.1302\/0301-620X.96B1.32168"},{"key":"141913","doi-asserted-by":"crossref","unstructured":"Kukkonen J, Joukainen A, Lehtinen J, Mattila K T, Tuominen E K, Kauko T, et al. Treatment of nontraumatic rotator cuff tears: a randomized controlled trial with two years of clinical and imaging follow-up. J Bone Jt Surg 2015; 97(21): 1729-37. doi: 10.2106\/jbjs.n.01051.","DOI":"10.2106\/JBJS.N.01051"},{"key":"141914","doi-asserted-by":"crossref","unstructured":"Kukkonen J, Ry\u00f6s\u00e4 A, Joukainen A, Lehtinen J, Kauko T, Mattila K, et al. Operative versus conservative treatment of small, nontraumatic supraspinatus tears in patients older than 55 years: over 5-year follow-up of a randomized controlled trial. J Shoulder Elbow Surg 2021; 30(11): 2455-64. doi: 10.1016\/j.jse.2021.03.133.","DOI":"10.1016\/j.jse.2021.03.133"},{"key":"141915","doi-asserted-by":"crossref","unstructured":"Lambers Heerspink F O, van Raay J J, Koorevaar R C, van Eerden P J, Westerbeek R E, van \u2018t Riet E, et al. Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial. J Shoulder Elbow Surg 2015; 24(8): 1274-81. doi: 10.1016\/j.jse.2015.05.040.","DOI":"10.1016\/j.jse.2015.05.040"},{"key":"141916","doi-asserted-by":"crossref","unstructured":"Moosmayer S, Lund G, Seljom U, Svege I, Hennig T, Tariq R, et al. Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff: a randomised controlled study of 103 patients with one-year follow-up. J. Bone Joint Surg. Br 2010; 92(1): 83-91. doi: 10.1302\/0301-620x.92b1.22609.","DOI":"10.1302\/0301-620X.92B1.22609"},{"key":"141917","doi-asserted-by":"crossref","unstructured":"Moosmayer S, Lund G, Seljom U S, Haldorsen B, Svege I C, Hennig T, et al. Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up J Bone Jt Surg 2014; 96(18): 1504-14. doi: 10.2106\/jbjs.m.01393.","DOI":"10.2106\/JBJS.M.01393"},{"key":"141918","doi-asserted-by":"crossref","unstructured":"Moosmayer S, Lund G, Seljom U S, Haldorsen B, Svege I C, Hennig T, et al. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. J Bone Jt Surg 2019; 101(12): 1050-60. doi: 10.2106\/jbjs.18.01373.","DOI":"10.2106\/JBJS.18.01373"},{"key":"141919","doi-asserted-by":"crossref","unstructured":"Constant C R, Murley A H. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987(214): 160-4.","DOI":"10.1097\/00003086-198701000-00023"},{"key":"141920","doi-asserted-by":"crossref","unstructured":"Richards R R, An K N, Bigliani L U, Friedman R J, Gartsman G M, Gristina A G, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 1994; 3(6): 347-52. doi: 10.1016\/s1058-2746(09)80019-0.","DOI":"10.1016\/S1058-2746(09)80019-0"},{"key":"141921","doi-asserted-by":"crossref","unstructured":"Kuhn J E, Dunn W R, Sanders R, An Q, Baumgarten K M, Bishop J Y, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg 2013; 22(10): 1371-9. doi: 10.1016\/j.jse.2013.01.026.","DOI":"10.1016\/j.jse.2013.01.026"},{"key":"141922","doi-asserted-by":"crossref","unstructured":"Lu Y, Sun B, Yang G, Li S, Jiang C. Arthroscopic repair benefits reparable rotator cuff tear patients aged 65 years or older with a history of traumatic events. Arthroscopy 2023; 39(5): 1150-8. doi: 10.1016\/j.arthro.2022.12.022.","DOI":"10.1016\/j.arthro.2022.12.022"},{"key":"141923","doi-asserted-by":"crossref","unstructured":"Jensen A R, Taylor A J, Sanchez-Sotelo J. Factors influencing the reparability and healing rates of rotator cuff tears. Curr Rev Musculoskelet Med 2020; 13(5): 572-83. doi: 10.1007\/s12178-020-09660-w.","DOI":"10.1007\/s12178-020-09660-w"},{"key":"141924","doi-asserted-by":"crossref","unstructured":"Lee Y S, Jeong J Y, Park C D, Kang S G, Yoo J C. Evaluation of the risk factors for a rotator cuff retear after repair surgery. AM J Sports Med 2017; 45(8): 1755-61. doi: 10.1177\/0363546517695234.","DOI":"10.1177\/0363546517695234"},{"key":"141925","doi-asserted-by":"crossref","unstructured":"Raman J, Walton D, MacDermid J C, Athwal G S. Predictors of outcomes after rotator cuff repair: a meta-analysis. J Hand Ther 2017; 30(3): 276-92. doi: 10.1016\/j.jht.2016.11.002.","DOI":"10.1016\/j.jht.2016.11.002"},{"key":"141926","doi-asserted-by":"crossref","unstructured":"Traven S A, Brinton D, Simpson K N, Adkins Z, Althoff A, Palsis J, et al. Preoperative shoulder injections are associated with increased risk of revision rotator cuff repair. Arthroscopy 2019; 35(3): 706-13. doi: 10.1016\/j.arthro.2018.10.107.","DOI":"10.1016\/j.arthro.2018.10.107"},{"key":"141927","doi-asserted-by":"crossref","unstructured":"Jeong H Y, Kim H J, Jeon YS , Rhee Y G. Factors predictive of healing in large rotator cuff tears: is it possible to predict retear preoperatively? Am J Sports Med 2018; 46(7): 1693-700. doi: 10.1177\/0363546518762386.","DOI":"10.1177\/0363546518762386"},{"key":"141928","doi-asserted-by":"crossref","unstructured":"Kwon J, Kim S H, Lee Y H, Kim T I, Oh J H. The Rotator Cuff Healing Index: a new scoring system to predict rotator cuff healing after surgical repair. Am J Sports Med 2019; 47(1): 173-80. doi: 10.1177\/0363546518810763.","DOI":"10.1177\/0363546518810763"},{"key":"141929","doi-asserted-by":"crossref","unstructured":"D\u00fczg\u00fcn \u0130, Baltac\u0131 G, Turgut E, Atay O A. Effects of slow and accelerated rehabilitation protocols on range of motion after arthroscopic rotator cuff repair. Acta Orthop Traumatol Turc 2014; 48(6): 642-8. doi: 10.3944\/aott.2014.13.0125.","DOI":"10.3944\/AOTT.2014.13.0125"},{"key":"141930","doi-asserted-by":"crossref","unstructured":"Jenssen K K, Lundgreen K, Madsen J E, Kvakestad R, Pripp A H, Dimmen S. No functional difference between three and six weeks of immobilization after arthroscopic rotator cuff repair: a prospective randomized controlled non-inferiority trial. Arthroscopy 2018; 34(10): 2765-74. doi: 10.1016\/j.arthro.2018.05.036.","DOI":"10.1016\/j.arthro.2018.05.036"},{"key":"141931","unstructured":"Zhang J L, Bai D Y, Yang J W, Luan Y J, Zhao C J. Early motion versus immobilization for arthroscopic repair in the treatment of large size rotator cuff tears. Biomed Res J 2017; 28: 6818-22."},{"key":"141932","doi-asserted-by":"crossref","unstructured":"Maugars Y, Varin S, Gouin F, Huguet D, Rodet D, Nizard J, et al. Treatment of shoulder calcifications of the cuff: a controlled study. Joint Bone Spine 2009; 76(4): 369-77. doi: 10.1016\/j.jbspin.2008.10.016.","DOI":"10.1016\/j.jbspin.2008.10.016"},{"key":"141933","doi-asserted-by":"crossref","unstructured":"Ahmed A F, Toubasi A, Mahmoud S, Ahmed G O, Al Ateeq Al Dosari M, Zikria B A. Long head of biceps tenotomy versus tenodesis: a systematic review and meta-analysis of randomized controlled trials. Shoulder Elbow 2021; 13(6): 583-91. doi: 10.1177\/1758573220942923.","DOI":"10.1177\/1758573220942923"},{"key":"141934","doi-asserted-by":"crossref","unstructured":"Saltzman B M, Zuke W A, Go B, Mascarenhas R, Verma N N, Cole B J, et al. Does early motion lead to a higher failure rate or better outcomes after arthroscopic rotator cuff repair? A systematic review of overlapping meta-analyses. J Shoulder Elbow Surg 2017; 26(9): 1681-91. doi: 10.1016\/j.jse.2017.04.004.","DOI":"10.1016\/j.jse.2017.04.004"},{"key":"141935","doi-asserted-by":"crossref","unstructured":"Sonoda Y, Nishioka T, Nakajima R, Imai S, Vigers P, Kawasaki T. Use of a shoulder abduction brace after arthroscopic rotator cuff repair: a study on gait performance and falls. Prosthet Orthot Int 2018; 42(2): 136-43. doi: 10.1177\/0309364617695882.","DOI":"10.1177\/0309364617695882"},{"key":"141936","doi-asserted-by":"crossref","unstructured":"Sridharan M J, Everhart J S, Frantz T L, Samade R, Neviaser A S, Bishop J Y, et al. High prevalence of outpatient falls following elective shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29(4): 699-706. doi: 10.1016\/j.jse.2019.11.019.","DOI":"10.1016\/j.jse.2019.11.019"},{"key":"141937","doi-asserted-by":"crossref","unstructured":"Moosmayer S, Ekeberg O M, Hallgren H B, Heier I, Kvalheim S, Juel N G, et al. Ultrasound guided lavage with corticosteroid injection versus sham lavage with and without corticosteroid injection for calcific tendinopathy of shoulder: randomised double blinded multi-arm study. BMJ (Clinical research ed.) 2023; 383:e076447. doi: 10.1136\/bmj-2023-076447.","DOI":"10.1136\/bmj-2023-076447"},{"key":"141938","doi-asserted-by":"crossref","unstructured":"de Witte P B, Selten J W, Navas A, Nagels J, Visser C P, Nelissen R G, et al. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med 2013; 41(7): 1665-73. doi: 10.1177\/0363546513487066.","DOI":"10.1177\/0363546513487066"},{"key":"141939","doi-asserted-by":"crossref","unstructured":"Witten A, Clausen M B, Thorborg K, H\u00f6lmich P, Barfod K W. The challenge of diagnosing patients presenting with signs and symptoms of subacromial pain syndrome: a descriptive study of 741 patients seen in a secondary care setting. Orthop J Sports Med 2025; 13(4): 23259671251332942. doi: 10.1177\/23259671251332942.","DOI":"10.1177\/23259671251332942"}],"container-title":["Acta Orthopaedica"],"original-title":[],"link":[{"URL":"https:\/\/actaorthop.org\/actao\/article\/download\/45410\/52851","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/actaorthop.org\/actao\/article\/download\/45410\/52869","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/actaorthop.org\/actao\/article\/download\/45410\/52870","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/actaorthop.org\/actao\/article\/download\/45410\/52851","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T13:31:57Z","timestamp":1771248717000},"score":1,"resource":{"primary":{"URL":"https:\/\/actaorthop.org\/actao\/article\/view\/45410"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,16]]},"references-count":34,"URL":"https:\/\/doi.org\/10.2340\/17453674.2026.45410","relation":{},"ISSN":["1745-3682","1745-3674"],"issn-type":[{"value":"1745-3682","type":"electronic"},{"value":"1745-3674","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2,16]]}}}