Subacromial pain/rotator cuff related pain

Subacromial pain is an umbrella term encompassing rotator cuff pathology, impingement and bursitis. It is frequently related to a change in activity. There is often pain in the shoulder and upper arm. Pain is usually worse on resisted abduction and rotation.

• History of trauma or change in activity levels, location of symptoms, severity and longevity of symptoms, limitation to function
• Night pain
• Exclude red flags.

• Assess neck movements/ neurology to exclude
• Pain or weakness on resisted muscle tests, commonly external rotation and abduction. (If significant weakness treat as a rotator cuff tear)
• Assess for presence of painful arc which may indicate a mechanical impingement
• Non capsular pattern of movement restriction.

XR if any history of trauma, to assess for calcific tendinitis, joint pathology and if not improving with first line management.

• Cervical spine/ radiculopathy
• OA shoulder
• Calcific tendinitis
• Consider red flags and Inflammatory pathology.

• Pain relief in line with agreed formularies/guidance
• Patient education, activity modification advice
• Advice to maintain range of motion and rotator cuff exercises
• Ensure patient is aware that exercises will not help straight away and may take several weeks to see a change
• Worsening statement given
• NHS AAA MSK website.

• Diagnostically uncertain
• Symptoms persist beyond despite first line conservative management.