Drawing of the shoulder labelling the location of various soft tissues and bones. Highlighted is the sub acromial space.Sub-acromial pain syndrome (SAPS) is when pain is felt on the outside of the upper shoulder.

This can develop or worsen over time or come on suddenly when starting a new activity you are not used to and cannot control.  

Anyone can develop sub-acromial pain however many factors can contribute towards its development. These include: 

  • Muscle weakness or imbalance 
  • Shoulder stiffness 
  • Posture 
  • Trauma, such as a fall
  • Age related change of the muscles/ tendons or joints of the shoulder

The most common symptoms associated with sub-acromial pain syndrome (SAPS) may include: 

  • An ache or sharp pain in the shoulder or upper arm that is often worse during lifting activities or when moving the arm above the head 
  • Pain felt when the arm is taken out to the side but eased when the arm is next to the ear (often described as a painful arc)
  • A feeling of stiffness or weakness when using the arm 
  • Discomfort lying on the painful side that could affect ability to sleep

Diagnosis is usually made from a consultation with your Health Care Professional, involving a detailed history of the onset of symptoms, current pattern of symptoms and your current functional ability. 

An image/scan is generally not needed to confirm sub-acromial pain. One may be performed if the Health Care Professional needs further information to finalise the diagnosis or if surgery is being considered. 

The primary aim of treatment is to help manage your pain. This allows you to move more and help you return to normal activities sooner. Initial treatment therefore is aimed at pain control. This might involve pain medication, or the use of heat or cold treatments. 

Once your pain is under control, working on the movement and strength of your shoulder is what will help long term.   

You can help to reduce pain, ease stiffness, strengthen your muscles and improve overall general fitness by keeping active. Below are some basic exercises specific to your shoulder to get you started. 

It is normal to experience some discomfort when doing exercises, and individuals may start at different points. Pain should not increase excessively during or immediately after the activity. Discomfort should return to pre-activity levels 24-48 hours after the activity has finished. 

The number (reps) and frequency (sets) of exercises suggested here are a guide, and should be performed to your personal tolerable pain levels. This means repetitions will vary between individuals and you should only go as far as is reasonably comfortable for you. 

 

Moving image of someone with their elbow bent, side on to a wall. They are pushing their hand outwards against the wallIsometric shoulder external rotation

Sit or stand up straight next to a wall. Keep your affected arm by your side and bend your elbow to 90 degrees. Place the back of your wrist against the wall. Without moving your body, press your wrist into the wall as if turning your forearm outwards. Hold this position and then relax.

 

 

Moving image of someone with their elbow bent, side on to a wall. They are pushing their elbow outwards against the wallIsometric shoulder abduction

Sit or stand up straight next to a wall. Keep your affected arm by your side and bend your elbow to 90 degrees. Place the outside of your elbow against the wall. Without moving your body, press your elbow into the wall. Hold this position and then relax.

 

 

 

Unless you have a serious injury or have sudden continuous severe pain, you can usually treat your shoulder pain without having to see your doctor. If after 2 weeks of treating yourself you feel the pain isn’t any better or is worsening, you should see a Health Care Professional 

You should also see a Health Care Professional if you: 

  • Have pain that doesn’t show any signs of improvement, within a couple of weeks of self help 
  • Have pain that has rapidly deteriorated or suddenly worsened despite self help 
  • Have pain, tingling, numbness or weakness in your face or arms  
  • Develop sudden stiffness in the shoulders and/or neck resulting in a lack of movement  
  • Are experiencing double vision, dizziness, nausea or sudden fainting 
  • Are noticing changes with your speech and/or difficulty swallowing 
  • Are noticing changes to your balance or walking pattern  
  • Are feeling clumsy or are falling more often 
  • Have a history of inflammatory arthritis, immuno-suppression, cancer, Tuberculosis (TB), drug abuse, AIDS or other infection 
  • Feel unwell, have a fever, or unexplained weight loss 
  • Are experiencing significant and regular changes to your usual sleeping pattern 
  • Have a history of recent injury (e.g. from a road traffic accident or a fall) or a history of shoulder surgery 
  • Have a new and visible deformed or misshapen shoulder 

If you do not have any of the above, you may be able to effectively self manage your condition 

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