About sub-acromial pain 

Subacromial pain is a common condition. It occurs in the shoulder and upper arm. It can feel worse when you move your arm away from your body.

The subacromial space is found between these areas in your shoulder:

  • the arm bone (humerus)
  • the shoulder blade (scapula)
  • the acromion (a bony projection on your shoulder blade).

Many structures run through this subacromial space. They include the tendons and muscles of your rotator cuff, ligaments and a fluid-filled sac (called a bursa).

Subacromial pain is caused by irritation to these tendons and bursa. 

Causes

Sub-acromial pain can be caused by:

  • muscle imbalance, or
  • a downward sloping shape, or bony spurs (growths), on the end of your acromion.

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The ASAD procedure

​We usually perform an ASAD to manage subacromial pain.

ASAD in full is an 'arthroscopic sub-acromial decompression of the shoulder'.

We carry out this keyhole surgery procedure while you are under general anaesthetic (asleep).

We can give you a nerve block as well, if needed. A nerve block is an injection of local anaesthetic (and sometimes steroids) around specific nerves to temporarily interrupt pain signals. 

During the ASAD, we will do the following:

  • make a small incision (cut)
  • reshape your acromion so that it is not compressing (pushing down on) your tendons and bursa so much.

Sometimes we need to:

  • remove some of the bursa because it has become inflamed
  • remove a small amount of extra bone that has formed.

After the procedure

Most patients go home on the day of the procedure. 

Occasionally we need to keep a patient in hospital overnight for observations, or to deal with complications from the procedure.

Before we discharge you, we will check your wound dressing and give you after-care advice.

Driving

Do not drive for at least 48 hours. This gives the anaesthetic time to wear off. 

If we have given you a sling to wear, you must not drive until you no longer need to wear it. (The sling may restrict some necessary movements and invalidate your insurance policy.)

When your pain level has reduced, you can drive short distances only.

Recovery at home

Arm movement

Avoid lifting heavy objects until your pain has eased off.

You can use your arm as usual for other activities. We advise you to gradually increase your range of movement as your muscle power increases and your pain level allows.

Your physiotherapist will discuss with you when you can return to playing sports.

Sling

If you were given a nerve block, we will give you a sling to use. This will protect your arm while the block wears off. You can stop using the sling when you regain normal feeling in your arm, and normal movement in your hand.

Pain

You can apply an icepack to the front of your shoulder, above the surgical wound site. This will help settle your pain. If you do not have an ice pack, you can use a packet of frozen peas wrapped in cling film and a teacloth (to keep your wound dressing dry). 

Sleeping

If you are finding it hard to sleep, you can try putting a pillow under your armpit or resting your arm on some pillows.

Washing

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When to seek urgent medical help

Seek urgent medical help if you notice any of the following.

  • Your wound begins to ooze, or becomes red, hot or swollen.
  • Your wound site starts to feel hot, and you have a higher temperature (above 38C) and feel feverish or generally unwell. This can indicate wound infection.
  • You start to feel breathless, or experience chest pain or a hot, painful and swollen calf or arm. This can indicate a blood clot. This is rare.

Exercises

Most patients can start doing these exercises immediately after their procedure.

If you were given a nerve block, you will need to wait until you regain sensation in your arm before beginning these exercises.

  • Try to complete each exercise 3 to 4 times a day.
  • Only do as much as your pain levels allow. It is a good idea to gradually build up the number of times you do each exercise.
  • It is better to do a little bit as often as possible (rather than one full set per day).

1.  Stand leaning on a table with one hand. Let your operated arm hang straight down and relaxed.

  • Swing your arm forwards and backwards.
  • Swing your arm to your left and then to your right.
  • Swing your arm in one direction as if drawing a circle on the floor.  Then swing it in the opposite direction.
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2.  Lie on your back with your elbows straight.

  • Use one arm to lift the affected arm up. Keep the affected arm as close to your ear as possible.
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3.  Sit on a chair with your affected arm stretched out and supported on a table.

  • Slide your arm away from your body as far as you can. Move it back so that it is beside your body.

When your pain level is under control, move onto exercises 4 and 5.

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4.  Stand and grip one end of a broom with your affected arm.

  • Lift the broom up, or forwards, or backwards, by using your good arm to help.
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5.  Stand facing a wall.

  • Walk your fingers up the wall, going as high as you can.
  • Walk your fingers down the wall in the same way.
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Follow-up

Approximately 2 weeks after your procedure, we will send you a follow-up appointment with your consultant, who will assess your shoulder. 

Your physiotherapist will also contact you about ongoing physiotherapy. This will begin 2 to 3 weeks after your procedure.

Contact information

Kingston Hospital Outpatient Physiotherapy Department

Telephone:

020 8934 2510