Shoulder Subacromial PainIssued by Physiotherapy Department

Northumbria HealthcareNHS Foundation Trust

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About your Shoulder

The shoulder is a ball and socket joint, called theglenohumeral joint. It is formed from a ball on the top ofthe arm bone (humerus) and a shallow socket which ispart of the shoulder blade (scapula).

Above the glenohumeral joint is a bony arch that is partof your scapula. The area between the glenohumeraljoint and the arch is known as the sub-acromial space.

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This leaflet provides information about shouldersubacromial pain.

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What can cause shoulder subacromial pain?

A group of muscles from the shoulder blade merge intoone united tendon called the ‘rotator cuff’. The rotatorcuff helps to control the ball on the socket and cansometimes be vulnerable to overloading, resulting inpain at the top of the arm. This pain is often morenoticeable on moving your arm away from your body,particlarly at shoulder height.

How common is it?

Extremely! It is the most common shoulder problem.20% of people will have symptoms at some time in theirlives. It most frequently begins in middle age (betweenthe ages of 45-65).

Self-help advice and exercises

• When using your arm try keeping your palm facingupwards. This is generally less painful.

• Think carefully about your posture, as poorposture could increase your chances of shoulderpain.

• Painless exercises can be started immediately.

• If your shoulder pain gets worse then stop andconsult your physiotherapist.

• Try to do the following exercises 1-2 times a day.

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Gently stretch yourarm up over yourhead (you can usethe other arm tohelp)

You can also do thisexercise in sitting.

Repeat 5 times.

Stand leaning on atable with one hand.Let your other armhang relaxedstraight down. Swingyour arm gentlyforwards andbackwards.

Repeat 10 times

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© PhysioTools Ltd

© PhysioTools Ltd

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In sitting or standing,position yourself as shownin this picture.Hold your shoulder bladesin this position, then restyour arms down by yourside, by relaxing yourelbows.Hold this position for 10seconds. Repeat 5 times.

Stand tall and keep thespine straight. Leanforwards at the pelvis andplace both hands on thetable with the fingers facingforward.Take the body weightthrough the hands andgently push the chest awayfrom the hands. Do notstrain.Hold for 10 seconds.Repeat 5 times.

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© PhysioTools Ltd

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Stretch one arm over tothe opposite shoulderby pushing it at theelbow with the otherarm.

Hold for 10 seconds.STOP if you experiencepain in the front of yourshoulder.

Repeat 3 times

Stand tall. Then pushthe forearm into thewall as if to rotate thearm outwards. Makesure the front of theshoulder does notmove forwards. Theelbow should not move.

Push for 10 seconds.

Repeat 5 times.

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© PhysioTools Ltd

© PhysioTools Ltd

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Alternative treatments

Injections

To help reduce the localised swelling and pain aninjection can be administered containing a mixture oflocal anaesthetic and corticosteroid.

The local anaesthetic starts to work immediately. Thesteroid will probably take longer to start working.

Although you may feel increased pain for the first 24hours. Injections can have a good effect because theywill help reduce pain and inflammation. As a result youcan start rehabilitation sooner and return to normalactivities more quickly.

U

l Improve function

Are there any risks?

• Some of the exercises may increase your paininitially. If you find your pain continues followingthe exercises, reduce the number of repetitionsyou perform. If your pain gets worse, then stopand consult your physiotherapist.

Benefits of exercises

• Help to reduce pain• Maintain your shoulder range of movement

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Pain Medication

You could discuss with a medical practitioner thepossible use of non steroidal anti inflammatory tablets(NSAIDS). You could also consider using topical creamsor gels.

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Until you have an appointment with your physiotherapistand to gain the most benefit from your injection it isadvisable that you rest from any strenuous activity oraggravating positions

What other tests can be done?

An X-ray may be taken, this only shows bones and doesnot show or tendon . If there is some suspicion that the tendon is torn you will be sent for an ultrasound scan or a MRI (magnetic resonance image). Both of these scans show the tendons and can help to diagnose a tear.

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Surgery

Treatment for shoulder impingement is usually non-surgical with only a very small proportion of peoplerequiring an operation.

If your symptoms do not settle with the above measuresan operation may be suggested.

The most frequent operation done is a ‘sub-acromial’decompression. This involves cutting the ligament andshaving away a small part of the bone. This can bedone by keyhole or open surgery. You are usually inhospital for a day.

The majority of people find their shoulder symptomssettle without the need for an operation.

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Contact details

If you need further advice of information please contact:

North Tyneside Hospital0191 2932723

Wansbeck General Hospital01670 564010

Hexham General Hospital01434 655031

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Notes

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PIN 407/V2

Review date: May 2018

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