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Subacromial Pain

Person having shoulder examined

What is Subacromial Pain?

Subacromial Pain Syndrome (SAPS) is a common condition that causes pain in the shoulder, specifically under the acromion (a bony prominence on the shoulder blade). It involves inflammation and irritation of the structures in the subacromial space, which includes the rotator cuff tendons, the bursa (a fluid-filled sac that helps reduce friction), and the tendon of the long head of the biceps. This condition can affect the way you move your shoulder and may lead to weakness or difficulty performing daily activities.

Causes of Subacromial Pain Syndrome

The primary cause of Subacromial Pain Syndrome (SAPS) is usually related to repetitive overhead motions or shoulder movements that put stress on the tendons and other tissues in the shoulder. Over time, this can lead to irritation and inflammation. Common causes include:
 
  • Repetitive overhead activities: Athletes who perform repetitive overhead motions, such as swimmers, tennis players, and baseball pitchers, are more likely to develop SAPS.
  • Rotator cuff tendinitis: Inflammation of the rotator cuff tendons is a leading cause of SAPS.
  • Shoulder impingement: The tendons in the subacromial space may become pinched or compressed due to changes in the shoulder joint’s alignment, causing pain and inflammation.
  • Bursitis: Inflammation of the subacromial bursa can also contribute to SAPS.
  • Degenerative changes: As people age, the rotator cuff tendons and bursa can wear down, making the shoulder more prone to injury.

Risk Factors

Several factors can increase the likelihood of developing Subacromial Pain Syndrome (SAPS):
 
  • Age: The condition becomes more common as people age, particularly in individuals over 40.
  • Occupation or sport: Jobs or sports that require repetitive arm motions, such as construction work or overhead sports, can increase the risk.
  • Poor posture: Misalignment of the shoulder or spine can contribute to abnormal movement patterns and increased stress on the shoulder.
  • Previous shoulder injuries: A history of shoulder injuries, such as a rotator cuff tear or dislocation, can lead to the development of SAPS.

Symptoms of Subacromial Pain Syndrome

The symptoms of Subacromial Pain Syndrome (SAPS) can vary from mild to severe and include:
 
  • Pain in the shoulder: This pain is often felt on the outer or front part of the shoulder and may be aggravated by overhead movements, lifting, or reaching.
  • Pain when sleeping: Lying on the affected side can cause pain and discomfort, often making it difficult to sleep.
  • Weakness: You may experience weakness in the shoulder, particularly when trying to lift or move your arm.
  • Limited range of motion: Difficulty raising the arm or reaching overhead due to pain and stiffness.
  • Clicking or popping: A feeling of grinding, clicking, or popping may occur when moving the shoulder.

How is Subacromial Pain Syndrome Diagnosed?

Diagnosis of Subacromial Pain Syndrome (SAPS) begins with a thorough physical examination by a healthcare provider. They will assess the range of motion, strength, and any signs of tenderness in the shoulder. In addition, your doctor may perform specific tests to evaluate the function of the rotator cuff and determine if the pain is related to impingement or other shoulder issues.
 
Imaging tests may be ordered to confirm the diagnosis or rule out other conditions:
 
  • X-rays: This helps identify bone spurs or changes in the structure of the shoulder joint that may be contributing to the pain.
  • Ultrasound: This can be used to visualize inflammation in the bursa or damage to the rotator cuff tendons.
  • MRI (Magnetic Resonance Imaging): An MRI provides detailed images of soft tissues, including the rotator cuff tendons and bursa, to assess for tears or inflammation.

Treatment for Subacromial Pain Syndrome

Treatment for Subacromial Pain Syndrome (SAPS) aims to reduce pain, restore function, and prevent further damage to the shoulder. The approach often includes a combination of the following:
 
  • Rest: Avoiding activities that cause or aggravate the pain is important to allow the shoulder to heal.
  • Physical therapy: A physical therapist will guide you through exercises to strengthen the rotator cuff and improve shoulder stability, as well as stretches to enhance flexibility and range of motion.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen or naproxen can reduce pain and inflammation.
  • Corticosteroid injections: For persistent pain, a cortisone injection into the subacromial space can provide temporary relief by reducing inflammation.
  • Ice and heat: Applying ice or heat to the affected area can help manage pain and inflammation.
  • Surgery: If conservative treatments fail, surgery may be considered. In some cases, arthroscopic surgery may be needed to remove damaged tissue, repair a tear in the rotator cuff, or remove bone spurs that are causing impingement.

Prevention of Subacromial Pain Syndrome

While it may not be possible to prevent Subacromial Pain Syndrome (SAPS) entirely, there are several steps you can take to reduce the risk:
 
  • Proper technique: Whether lifting weights, playing sports, or working, use proper form to avoid putting excessive strain on your shoulder.
  • Strengthening exercises: Regularly engage in exercises that strengthen the rotator cuff and improve shoulder stability.
  • Stretching: Incorporate stretching into your routine to maintain flexibility and prevent muscle tightness.
  • Take breaks: If you perform repetitive overhead tasks, take regular breaks to give your shoulder a rest and reduce the strain on your muscles and tendons.
  • Posture correction: Be mindful of your posture, especially during activities that involve long periods of sitting or standing.

Outlook for Subacromial Pain Syndrome

The prognosis for Subacromial Pain Syndrome (SAPS) varies depending on the severity of the condition and how quickly treatment is initiated. With early intervention and appropriate management, most individuals experience significant improvement in pain and shoulder function. However, if left untreated or if the condition progresses, it can lead to chronic pain, limited mobility, and long-term disability. In severe cases, surgery may be required, but most individuals recover well with physical therapy and conservative measures.
 
Maintaining a healthy lifestyle with regular exercise, good posture, and activity modifications can help prevent recurrence and improve long-term outcomes.

Further Information

Last updated23 Jun 2025
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