About sub-acromial shoulder pain (SASP)

What is SASP?

• SASP is the medical name for pain arising from the sub-acromial space of the shoulder.
• It is also commonly referred to as shoulder impingement or rotator cuff related shoulder pain.
• There are a number of structures in the sub-acromial space that can cause pain – these include the sub-acromial bursa and rotator cuff tendons
• SASP incorporates all conditions related to these structures that could cause pain – such as sub-acromial bursitis, rotator cuff degeneration or tendinopathy and rotator cuff tears.
• Pain is commonly located at the top and outside of the shoulder, aggravated by overhead activities and can cause night pain.

Watch the sub-acromial shoulder pain video (Credit to Somerset NHS Foundation Trust).

What causes SASP?

• The main cause is believed to be excessive load on the shoulder tissues, which can be over a long period of time or sudden.
• Repetitive movements at or above shoulder height and heavy lifting.
• Studies have shown links between SASP and metabolic syndromes such as diabetes, obesity, high cholesterol and high uric acid levels which can cause systemic inflammation.

Facts about sub-acromial shoulder pain(SASP)

• It affects 1 in 5 people at some stage in their life
• SASP is the most common disorder of the shoulder
• SASP is common in individuals who do heavy manual work
• Typically affects people between the ages of 35 and 75
• Accounts for between 44% to 65% of all shoulder complaints

Treatments and management

There are various treatment options available for SASP. These include education, pain management, exercise and potential surgery. In most cases imaging tests such as x-rays, magnetic resonance images (MRIs), or ultrasounds are not required to diagnose SASP. Scans are not always useful in diagnosing shoulder pain and although they can provide information about how the shoulder structures look, they don’t always change the treatment or management options available. Still, health care providers do sometimes arrange them to help diagnosis and to help guide treatment and management.

Patient education

Patient education is an important part of the management of SASP.  Knowing more about the condition can help alleviate fears and concerns. Simple advice regarding modifying your daily activities can reduced the stress or load on your shoulder and help symptoms.

Pain management

• Paracetamol is a common painkiller which can be used to help treat your shoulder aches and pain. However, you should not take this with anything else that contains paracetamol.
• Anti-inflammatory medication (NSAIDs): These include medications such as Ibuprufen, Diclofenac, and Naproxen which can help ease pain and reduce any inflammation in the shoulder. These are usually only recommended in short course with advice from your GP or pharmacist.
• Steroid injection: Cortico-steroid is a powerful anti-inflammatory drug that can be injected into the sub-acromial space or bursa. It is important to know that this is not a cure, however it can give good pain relief to allow symptoms to be more manageable.
  Continuing with physiotherapy and your exercise programme following steroid injections is important to achieve longer benefits and pain relief