Subacromial Shoulder Pain

What is it?

Subacromial pain can also be known as rotator cuff related shoulder pain, rotator cuff tendinopathy or shoulder impingement.  The reason for the different names is largely due to some uncertainty among experts over the accuracy of diagnosis.  The subacromial space is the region situated above the ball and socket (glenohumeral) joint and beneath the bony tip of the shoulder known as the acromion. The rotator cuff is a group of four muscles that run from the shoulder blade to the top of the arm bone thus encapsulating the ball and socket joint. Some of their tendons are situated in the subacromial space along with another structure known as a bursa.  It is thought that subacromial pain is related to irritation of these soft-tissue structures but there are typically many factors that are involved.

How does it happen?

Often, subacromial pain results from overuse or injury to a rotator cuff tendon.  The most commonly involved tendon is that of the supraspinatus muscle.  The tendon of supraspinatus runs through a small space between the top of the arm bone and the point of the shoulder known as the subacromial space.  There is some debate about the mechanisms behind subacromial pain, however if the structures become irritated they will become enlarged thus occupying more of the surrounding space.

How does it feel?

Pain is often felt in the upper arm region.  This is usually felt when lifting the arm in the air and symptoms typically come on gradually.  Initially, it may only be painful following exercise and may not be present during exercise.  However, as you continue to participate, the pain can become more intense and frequent.  It may begin to be present during participation. In the early stages this pain may wear off during exercise only to return more prominently once you stop.  As you continue to participate irritation worsens and your pain may begin to be present for longer periods until it is present each time you lift your arm.

What should you do?

Rest can allow symptoms to ease, however they are likely to return as you resume previous activity levels if causative factors are not addressed.  People can often fall into the ‘boom or bust’ scenario without appropriate advice and intervention.  If you have or suspect you have subacromial pain, you should consult a physiotherapist or musculoskeletal expert.  There is good evidence to support physiotherapy, particularly exercise-based approach, however manual therapy may be beneficial to assist with pain-relief.  In some circumstances injections can be beneficial.  The Ultrasound Scan & Injection Clinic at Life Fit Wellness offers physiotherapy, diagnostic ultrasound scan and injections as indicated.  

In the meantime, you can try applying some ice to the area but for pain relief and try to keep the arm comfortably mobile (i.e. do as much as you can without aggravating your symptoms).