Subacromial pain syndrome

Shoulder subacromial pain syndrome potentially results in pain, weakness and loss of movement of the shoulder usually with overhead activities.

It is most common in individuals over 40 years old. It often associated with change in activities, particularly when due to overuse e.g. increase in gym or repetitive overhead activities.

The subacromial bursa and rotator cuff muscle tendons lie within the sub-acromial space. Subacromial pain refers to a condition where these structures get irritated within the subacromial space, usually when the arm is raised above shoulder height, resulting in pain down the upper outer arm.

While the majority of cases arise from overuse, poor posture, chronic damage to the rotator cuff tendons, poor muscle function and spurs from the adjacent acromioclavicular joint may be contributing factors.

Most commonly, pain is felt in the front and side of the shoulder area.

Commonly, individuals may suffer from referred pain radiating down the upper arm to the elbow.

Pain on movements of the arm above the head, behind the back and across the body are the main aggravating activities.

If there is a significant structural cause for the symptoms, the movements of the shoulder may become increasingly stiff with reduced range of movement.

Subacromial pain syndrome can be diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main features on examination are often pain and limitation with movements of the arm above the head.

X-rays or other scans are not routinely required but may be requested prior to considering a corticosteroid injection or if there is concern regarding the possibility of a tear to a rotator cuff tendon.

Surgery is rarely required and the majority of patients can be managed conservatively (without surgery).

Non-surgical management

Modifying activity

As the condition is often triggered by strenuous or repetitive overhead activities modification and avoidance of aggravating activities is important initially.

Exercises

In the majority of cases, subacromial pain syndrome can be managed very effectively by following a regular exercise routine to optimise flexibility, strength and coordination of the affected shoulder joint: These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your GP or Physiotherapist.

Using painkillers when needed

Over-the-counter analgesia is available through pharmacies when needed. Paracetamol is most commonly prescribed. Anti-inflammatories, such as Ibuprofen, are also used, but as there is little or no inflammation involved in osteoarthritis these are best avoided without discussing with your GP. Side effects are even more common than with paracetamol so please ensure to take appropriate medical advice. There is a good booklet on the Arthritis Research UK website with information about the various drug options.

Corticosteroid injection therapy

For individuals with subacromial pain syndrome who continue to suffer disabling symptoms despite a course of supervised exercises, a corticosteroid injection can be offered as the next line of treatment. Where symptoms are severe and patients are unable to engage in physiotherapy, an injection may be offered to improve pain prior to starting rehabilitation. You can read more about local corticosteroid injections here.

Surgical management

If non-surgical management outlined above does not resolve symptoms, your clinician may offer a referral for consideration of surgical treatment.

This usually takes the form of sub acromial decompression, a procedure that involves clearing the subacromial space to allow pain free movement. It should be noted, however, that proper rehabilitation after surgery is necessary to ensure optimal outcome.