Subacromial Pain Syndrome
Subacromial pain syndrome is a commonly occurring problem in the shoulder. It results in pain in the region of the shoulder and upper arm which is typically aggravated by lifting the arm to shoulder height and lying on the affected side. The label 'subacromial pain syndrome' is an umbrella term that encompasses different pathologies and symptoms that can occur in the subacromial space of the shoulder. These include conditions of the rotator cuff, subacromial bursa and subacromial impingement.
Common symptoms are pain and/or weakness when lifting the arm to shoulder height and pain when lying on the affected shoulder. It is often aggravated by repeated above head activity such as painting or trimming a hedge. Pain is not always apparent during the activity but may become noticeable over the following days. It is not uncommon to wake with with pain and stiffness of the shoulder that eases somewhat with movement.
It can start quite suddenly after an injury such as a fall onto the shoulder or outstretched arm. Or it may begin gradually after unaccustomed activity such as painting or gardening. A repetitive overhead activity at work or during a hobby can also trigger this pain. It may, however, be difficult to attribute the onset of pain to a particular activity and it is likely that many factors contribute to the development of subacromial pain.
Studies investigating this type of shoulder pain have shown that the vast majority of people will get better with rest, simple pain relief and physiotherapy - without the need for injections or surgery.
Resting from aggravating activities is important, particularly in the early stages, and this can help prevent it from developing into a longstanding, chronic problem. This is not always an easy thing to do due work, home life commitments and hobbies. At Yorkshire Shoulder Physiotherapy we will assess this and advise ways in which you can modify activities to prevent further aggravation.
The short term use of simple pain killers, such as paracetamol or anti inflammatories, can be useful in the management of subacromial pain. Always take as recommended on the box and seek advice from your doctor or pharmacist first if you are taking other medication.
Research has shown that physiotherapy can be very successful in the treatment of subacromial pain. This is generally exercise based and aims to reduce inflammation, improve strength and restore pain free movement whilst identifying and correcting the possible causes to reduce the risk of reoccurrence. Manual therapy techniques, such as joint mobilisations, may be useful for pain relief and for improving shoulder movement. At YSP we will assess your shoulder and provide a tailored program to improve strength and movement. We will apply the latest clinical research and evidence to treat your shoulder pain.
Injections can be useful in the management of this type of shoulder pain but in most cases it is a last resort. This is because the benefits are often only short lived and in most cases rest, simple pain killers and physiotherapy can resolve the problem without the need for an injection. For some people, despite rest and pain killers, the shoulder is too painful to participate in physiotherapy. In these circumstances, short term pain relief from an injection can provide a window of opportunity to strengthen the rotator cuff and improve movement and function in the shoulder. An injection in isolation is not the answer to subacromial pain.
A very small proportion of people with subacromial pain may require a keyhole procedure called a subacromial decompression. In most cases, surgeons will not consider operating on this condition until at least three months of physiotherapy has been completed. At Yorkshire Shoulder Physiotherapy if your shoulder pain does not improve as expected, and you wish to have surgical opinion, we can refer you to a local specialist surgeon.