Subacromial pain is also referred to as shoulder impingement. It is the friction of soft tissue structures in the shoulder that causes pain and/ or weakness when moving the shoulder. This pain may be made worse by lifting the arm above the head. The pain originates from the subacromial space normally on the outside top of the shoulder joint. In this space there are tendons of the rotator cuff muscles crossing with the glenohumeral joint. Any inflammation or damage to the tendons can cause narrowing of this space in turn producing symptoms through compressive forces.
Symptom and presentation
Symptoms of subacromial pain (impingement) can either begin suddenly after an injury to the shoulder complex or it can present gradually with no known cause. With this type of injury, the shoulder will not normally present with stiffness, therefore if you have stiffness you must seek medical advice.
- Weakness in the arm
- Pain that increased when moving the arm (particularly movement to and from overhead)
- Pain located round the top outer side the shoulder
- Pain that is aching in nature
- Pain at night that is affecting sleep
Initially when treating this type of pain, it is very much dependent on the, activity level, age and general health of the patient. The first aim of treatment if always conservative, with the use of exercise prescription to strengthen the shoulder complex and to aim to re-open the subacromial space that has been affected often with the use of NSAIDs to reduce inflammation and pain. In some cases, a steroid injection may be another treatment approach, cortisone is often used because of its high anti-inflammatory and pain reducing effects. In most cases conservative treatment should resolve the pain within a year your shoulder should be pain free. If this approach fails, surgery will be considered.
Her are a some types of procedures that may be required if conservative management is not successful:
Bursectomy – Removal of subacromial bursa
Subacromial decompression – To regain adequate space within the shoulder by the removal of bony spurs
Acromioplasty – Similarly the procedure is to increase the subacromial space by removing part of the acromion.
Surgical repair – Surgically repairing any damaged tissues, most commonly this is the supraspinatus muscle or the long head of biceps tendon.
In most cases seeking medical advice is the fastest and safest way to recovery, there are a number of self-management techniques that can help to reduce symptoms and decrease recovery time from an injury like this. Initially you should try to avoid any activities that provoke pain and any activities that involve lifting your arm overhead should be avoided as well as sports such as swimming, tennis, cricket etc.
Other forms of self-care:
- Do not stop moving your arm completely – try to carry on with daily activities as much as possible to avoid the shoulder becoming stiff
- Rotator cuff strengthening exercises
- Anti-inflammatory pain killers – such as paracetamol and ibuprofen may help reduce symptoms
- RICE (reduction of pain and swelling)– in the first twenty four to forty eight hours after the injury presenting you should follow the RICE protocol. Applying ice to the area for fifteen minute intervals throughout the day.
R-rest I-ice C– compression E-elevation
Strengthening and mobility exercises including capsular stretching – although theses should be prescribed where possible by a physiotherapist.
If symptoms persist you should seek medical attention.