Subacromial pain syndrome

What is subacromial pain in adults?

Subacromial pain in adults is one of the most common causes of non-traumatic shoulder pain and is a normal part of ageing. It also can be known as ‘rotator cuff disease’, which is thought to be the wear and tear of the rotator cuff tendons.

The rotator cuff tendons hold the shoulder joint in place and allow people to lift the arm and reach overhead. When the arm is lifted, the rotator cuff tendon passes through a narrow space at the top of the shoulder, known as the sub-acromial space. Most rotator cuff tears occur within the tendon or on the 'under-side' of the tendon.

Shoulder impingement (pain in the top and outer side of the shoulder) will often improve in a few weeks or months, especially with prescribed shoulder exercises.


Arthroscopic sub-acromial decompression is a series of surgical ‘keyhole’ procedures to different parts of the shoulder. It involves decompressing the sub-acromial space by removing bone spurs and soft tissue arthroscopically.


There is a small risk of infection, worse pain, stiffness and damage to the nerves and blood vessels around the shoulder. In some cases, the surgery may need to be done again.

Eligibility criteria:

Due to the limited quality of evidence of clinical and cost effectiveness, surgery for sub-acromial pain syndrome is not routinely commissioned.

This means the patient’s NHS commissioning organisation (CCG), who is responsible for buying healthcare services on behalf of patients, will only fund the treatment if an Individual Funding Request (IFR) application has shown exceptional clinical need and the CCG supports this.

Advice and further guidance:

Treatment policy for patients covered by NHS Birmingham and Solihull CCG

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