Subacromial Pain

Subacromial impingement is a term used for a wide range of conditions that cause pain originating from the subacromial space of the shoulder. Various terms have been used to describe this such as tendinitis and bursitis. Pain is experienced when the subacromial space is narrowed and causes inflammation of the tissue present in the subacromial space called the ‘bursa’.

Pain is often felt over the point of the shoulder and upper arm and radiates down towards the elbow. Pain in the shoulder is commonly increased by reaching up to a high shelf or reaching behind to put the affected arm into the sleeve of a coat. This may be severe. It may also cause pain that is particularly noticeable at night even when not moving the arm. The pain can lead to weakness of the arm if the problem is ongoing.

Subacromial impingement is usually a clinical diagnosis which a specialist makes after taking a history and performing a clinical examination. Usually the only test needed for a diagnosis of subacromial impingement is an x-ray of the shoulder to look for other causes of subacromial impingement such as calcific tendinitis.

Yes. Rest, anti-inflammatory medication and avoiding activities that cause pain help the shoulder recover.

Do avoid things that make the pain worse – avoid activities that involve repeatedly lifting your arm above your head (such as swimming or playing tennis) for a few days or weeks. Ask a GP or physiotherapist when you can restart these activities.

Do take painkillers – anti-inflammatory painkillers (such as ibuprofen) or paracetamol may help. A GP can prescribe stronger painkillers if needed.

Do hold an ice pack (or a bag of ice cubes or frozen vegetables) to your shoulder for around 20 minutes several times a day – but do not put it directly on your skin. Wrap it in a towel first.

Don’t stop moving your arm completely – try to carry on with your normal daily activities as much as possible so your shoulder does not become weak or stiff. It’s usually best to avoid using a sling.

Pain killers and anti-inflammatory medication may help reduce pain. Physiotherapy can help to strengthen the rotator cuff muscles and improve symptoms. Sometimes physiotherapy increases symptoms of pain in which case an anti-inflammatory steroid injection into the bursa can help to reduce inflammation and pain. The effect of this is to allow the physiotherapy exercises to be more comfortable to perform so that they are more effective in providing long-term benefits.

Surgery may be necessary if these treatments fail. Arthroscopic (keyhole) surgery is performed to increase the subacromial space and remove the inflamed bursa. This is called a subacromial decompression.

Arthroscopic subacromial decompression is a day-case procedure performed under a regional anaesthetic nerve block which numbs the whole arm. The patient is awake for the duration of the procedure which enables them to go home sooner after surgery. The arm will be in a sling for up to 24 hours whilst the nerve block is working and then removed to allow exercises to start. Painkillers will be prescribed for when the nerve block wears off. Physiotherapy exercises should be started as soon as possible to maintain and improve the gains made by surgery. The patient visits their GP 10 days after surgery for removal of stitches if this is necessary and regular physiotherapy visits are booked. Mr Wijeratna sees patients in clinic 3 months after surgery and discharges the majority of patients at that point.