Subacromial Shoulder Pain

Subacromial Shoulder Pain: A Detailed Overview

Subacromial shoulder pain is a common condition that can significantly affect an individual’s quality of life. It is often associated with impingement of structures in the subacromial space of the shoulder joint.

What is subacromial shoulder pain?

Subacromial shoulder pain refers to discomfort or pain experienced in the space above the ball and socket joint (glenohumeral) and below the acromion process of the scapula (shoulder blade). It is often attributed to impingement of the tendons of the rotator cuff and the subacromial bursa against the acromion and coracoacromial ligament during shoulder movement.

What are the causes?

This shoulder condition can be caused by various factors, but most commonly is due to rotator cuff impingement or rotator cuff tendinopathy (shoulder impingement). This is usually due to repetitive overhead activities or shoulder movements that lead to compression and irritation of the rotator cuff tendons within the subacromial space.

Alternatively, it can be due to shoulder arthritis, calcific tendonitis or subacromial bursitis. Sometimes, bone spurs on the under surface of the acromion can narrow the subacromial space, leading to impingement and pain.

What are the symptoms?

This condition typically presents as persistent pain in the shoulder and upper arm that can spread further down the arm to the elbow and into the neck, especially during overhead activities or reaching behind the back. There is difficulty moving the shoulder, particularly when lifting the arm or rotating it outward and pain worsens at night, particularly when lying on the affected shoulder.

How is subacromial shoulder pain diagnosed?

Subacromial shoulder pain can be diagnosed by your London Shoulder Specialist, typically with a comprehensive physical examination, assessing the range of motion. They will talk through your symptoms and medical history including any precipitating factors or previous injuries.

X-rays are commonly used to visualise the structures within the shoulder joint, assessing any abnormalities or signs of impingement. In more complex cases, magnetic resonance imaging (MRI) scans may be performed. Then, they can advise on either non-surgical or surgical treatments.

What are the treatment options?

Treatment aims to alleviate pain, improve shoulder function, and address any underlying causes. In mild cases, the RICE protocol (rest, ice application and compression), along with anti-inflammatory medication can help alleviate pain and reduce swelling. After this, physical therapy is advised with an exercise plan for restoring strength, stability, and range of motion in the affected shoulder.

UK guidelines recommend ultrasound guided injection to manage pain by reducing pain and improving function, performed alongside physiotherapy. These injections should work within three to five days and should relieve pain for several weeks or months or permanently when combined with physiotherapy. The number of injections that can be done is limited. If there is a rotator cuff tear, then a rotator cuff tear surgery may be required.

Is surgery always necessary?

Surgery is not always necessary, especially in the early stages or when conservative treatments are effective. However, if symptoms persist despite treatment, surgical intervention may be considered. Common surgical procedures for subacromial shoulder pain include subacromial decompression and rotator cuff repair.

Can subacromial shoulder pain be prevented?

While it may not be entirely preventable, certain measures can help reduce the risk of developing subacromial shoulder pain:

Proper lifting techniques during activities can help minimise strain on the shoulder joint. Also, gradually increase the intensity and duration of activities to allow the shoulder joint to adapt and strengthen over time.

Also, maintaining good posture, including keeping the shoulders back and down, to reduce stress on the shoulder joint and prevent impingement.

Can lifestyle changes help?

Adopting certain lifestyle changes can help manage subacromial shoulder pain and improve shoulder health. Engaging in regular shoulder-strengthening exercises and flexibility routines can help to improve shoulder mechanics and reduce the risk of impingement.

Subacromial shoulder pain can be diagnosed by your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.