Subacromial Shoulder Pain
Subacromial pain is one of the commonest complaints related to the shoulder, which commonly affects active individuals. The condition, which is also known as “rotator cuff tendinopathy” or “impingement syndrome”, usually commences with insidious onset of pain in the shoulder. Occasionally the pain may follow an injury to the shoulder.
Subacromial Shoulder Pain
The shoulder is a complex joint that allows for a wide range of motion. However, it is also prone to various types of pain and injuries. One common type of shoulder pain is subacromial shoulder pain.
What is subacromial shoulder pain?
Subacromial shoulder pain refers to the pain experienced in the shoulder area, specifically in the subacromial space. The subacromial space is the area between the top of the upper arm bone (humerus) and the acromion, which is the bony projection of the shoulder blade (scapula). This space contains various structures, such as tendons, ligaments, and a fluid-filled sac called the bursa.
When there is inflammation or damage to these structures, it can result in subacromial shoulder pain. This condition is often caused by repetitive overhead activities, such as throwing, lifting, or reaching. It can also be caused by trauma, such as a fall or a direct blow to the shoulder.
Causes of subacromial shoulder pain
There are several factors that can contribute to the development of subacromial shoulder pain. One common cause is rotator cuff tendinitis, which occurs when the tendons of the rotator cuff become inflamed or irritated. This can be a result of overuse, poor posture, or sudden increases in physical activity.
Another cause of subacromial shoulder pain is shoulder impingement syndrome. This occurs when the structures in the subacromial space become compressed or pinched, leading to pain and limited range of motion. Shoulder impingement syndrome can be caused by repetitive overhead activities, structural abnormalities in the shoulder joint, or muscle imbalances.
In some cases, subacromial shoulder pain may be caused by a tear in the rotator cuff. This can occur as a result of trauma or degenerative changes in the tendons. Other potential causes of subacromial shoulder pain include bursitis, arthritis, and shoulder instability.
Symptoms of subacromial shoulder pain
The symptoms of subacromial shoulder pain can vary depending on the underlying cause and severity of the condition. Common symptoms include:
- Pain: The primary symptom of subacromial shoulder pain is pain in the shoulder area. The pain may be sharp, dull, or achy, and it may worsen with certain movements or activities.
- Weakness: Some individuals with subacromial shoulder pain may experience weakness in the affected shoulder. This can make it difficult to perform certain tasks or activities that require strength and stability.
- Limited range of motion: Subacromial shoulder pain can also lead to limited range of motion in the shoulder joint. This may make it challenging to move the arm freely or perform overhead activities.
- Swelling and inflammation: Inflammation and swelling can occur in the shoulder joint, causing discomfort and visible swelling in some cases.
- Clicking or popping sensations: Some individuals may experience clicking or popping sensations in the shoulder joint during movement. This can be a result of structural abnormalities or damage to the shoulder structures.
Diagnosing subacromial shoulder pain
If you are experiencing symptoms of subacromial shoulder pain, it is important to seek medical evaluation for an accurate diagnosis. An orthopedic surgeon, will perform a thorough examination of your shoulder and may order additional tests, such as imaging studies or diagnostic injections.
During the examination, the orthopedic surgeon will assess your range of motion, strength, and stability of the shoulder joint. They will also evaluate your medical history and ask about the onset and nature of your symptoms. These evaluations will help determine the underlying cause of your subacromial shoulder pain and guide the appropriate treatment plan.
Treatment options for subacromial shoulder pain
The treatment options for subacromial shoulder pain can vary depending on the underlying cause, severity of symptoms, and individual factors. In many cases, conservative, non-surgical treatments are effective in relieving pain and improving shoulder function. However, in some cases, surgical intervention may be necessary.
Non-surgical treatments for subacromial shoulder pain
- Rest and activity modification: Resting the affected shoulder and avoiding activities that exacerbate the pain can help reduce inflammation and promote healing. Your orthopedic surgeon may also recommend modifying certain movements or activities to prevent further irritation.
- Physical therapy: Physical therapy is a key component of non-surgical treatment for subacromial shoulder pain. A physical therapist will design a customized exercise program to improve shoulder strength, stability, and range of motion. They may also incorporate modalities such as heat, cold, or electrical stimulation for pain relief.
- Medications: Over-the-counter or prescription medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, may be recommended to reduce inflammation and alleviate pain. These medications should be used under the guidance of an orthopedic surgeon.
Surgical options for subacromial shoulder pain
If symptoms continue despite sufficient nonoperative therapy, surgical intervention may be considered appropriate. This typically involves arthroscopic or “keyhole” surgery aimed at decompressing the subacromial space by removing some bone from the undersurface of the acromion. After surgery, symptoms generally subside gradually over time.
Rehabilitation and recovery for subacromial shoulder pain
Following surgery or as part of conservative treatment, rehabilitation plays a crucial role in the recovery process for subacromial shoulder pain. A physical therapist will guide you through a progressive rehabilitation program tailored to your specific needs. This will typically involve exercises to restore strength, flexibility, and range of motion in the shoulder joint.
It is important to follow the guidance of your healthcare professionals, including any prescribed exercises or activity modifications, to optimize your recovery and prevent further injury. With proper treatment and rehabilitation, the majority of individuals with subacromial shoulder pain can regain full function and return to their normal activities.
The tendons of the rotator cuff suffer wear and tear over time. This results in thickening of the tendons and occasionally there is some roughness on the undersurface of the acromion or a spur, which impinges on the rotator cuff when the arm is elevated resulting in pain. In some instances there may be a partial or complete tear of the rotator cuff tendons. Sometimes pain may be related to wear and tear in the tendon of the long head of the biceps.
A diagnosis is made based on the history of a painful shoulder. Pain is usually intermittent and experienced when reaching overhead and often when lying on the shoulder at night. Examination shows pain with certain movements of the shoulder (such as lifting the arm above shoulder height) and on special rotator cuff tests. An X-ray may be useful to look at the shape of the acromion and the rest of the joint. An ultrasound scan may be performed to examine the state of the rotator cuff. Special imaging with an MRI scans is sometimes necessary.
In the early phase, pain may be controlled with activity modification and the use of pain relieving or anti-inflammatory medication.
Supervised physiotherapy: You may be advised to see a physiotherapist to start a regime of specific exercises to maintain movements and improve the function of the rotator cuff. There is good evidence to suggest that supervised physiotherapy improves symptoms in the early phase of the condition. The British Elbow and Shoulder Society (BESS) Patient resource on Subacromial Pain has useful information including a help sheet and description of exercises with videos.
Steroid injection: A steroid injection placed accurately into the subcromial space will often provide good short to medium term pain relief allowing progress to be made with physiotherapy. The injection may be repeated on one or two occasions at intervals. It is not advisable to have multiple repeated injections. For further information on steroid injections click here.
Surgery: If symptoms persist despite adequate nonoperative treatment, it may be appropriate to undertake surgical treatment. This consists of arthroscopic or “key-hole” surgery to decompress the subacromial space by shaving some bone from the undersurface of the acromion. Following surgery symptoms will usually settle over a period of time. For further information on surgical treatment, please refer to the procedures section.