Shoulder Showdown: Winning the Fight Against Subacromial Pain!
One of the most common reasons for a painful shoulder is subacromial pain syndrome (SAPS). The name ‘subacromial’ refers to an area in the shoulder that is below a bone called acromion that is located at the top of the shoulder. Due to lack of universally recognised terminology, it is also known as rotator cuff tendinopathy, rotator cuff related shoulder pain or shoulder impingement. To make it even more complicated, it can also be labelled as bursitis, biceps tendinitis, partial tear or degeneration of the rotator cuff. However, they are all part of SAPS, which is the term recommended to be used (Witten et al 2023; Diercks et al 2014).
If you have gone to see someone about your achy shoulder, it is highly likely that it’s caused by an issue in the subacromial space of the shoulder (Tangrood et al 2021). Whether you’re an athlete, work in a physically demanding job or engage in repetitive shoulder movements, understanding the causes and treatment options can help you manage the condition effectively.
Subacromial pain syndrome can start quite slowly, gradually getting worse with time. It can also make itself known after doing too much of an activity that you are unaccustomed to that involves the shoulder, such as lifting, throwing or pushing. For example, it could be that the fence around your house needs repainting, and you finally have the time to do it over the weekend, which might have left your shoulder a bit overworked and sensitive. It has been shown that people with diabetes, hypertension or hyperlipidemia (high cholesterol) are more likely to suffer from shoulder pain. Smokers and people with higher body mass index (BMI) are also at more risk developing shoulder pain (Giri et al 2023; Baumgarten et al 2010; Ozkuk and Ates 2020). On the other hand, it seems that regular exercise has a preventative effect on the risk of shoulder pain (Diercks et al 2014).
It presents as pain around the shoulder area, it is possible for it to radiate down the upper arm but not below the elbow. Most commonly arm movements away from the body are the ones that make the symptoms worse. Such as trying to reach behind the back or lifting the arm up, but this can vary between individuals.
There are several options for you to try to improve and recover.
Exercise is considered to be a first-line treatment for subacromial pain (Clausen et al 2021). However, it is unclear what type or how much exercise is best. Researchers have looked at different types and intensities of exercise and concluded that there is no best exercise for subacromial pain. But significant improvements can be made regardless of the type of exercise as long as it is done for long enough (Littlewood et al 2015). Alongside exercise, for temporary relief of symptoms ice or heat can be applied to the painful area too.
Corticosteroid injection is another option. However, Mohamadi et al (2016) showed that having an injection helped to reduce pain slightly for only about 20% of people for 4-8 weeks. That is not a long time. On top of that, steroid injections do not come without any risks. It has been shown that injections can damage tendons and lead to an increased risk of rotator cuff tears (Dean et al 2014; Lin et al 2022).
And lastly – surgery. This trial that was done by Beard et al in 2018 showed that patients who underwent arthroscopic subacromial decompression surgery improved, however, the results were no better than having a placebo surgery. It remains as an option for those suffering from subacromial pain, however, other treatment methods should be exhausted first before considering surgery.
In conclusion, subacromial shoulder pain can be a persistent and frustrating issue to deal with, but understanding its causes and management options can make a significant difference.
