From the Guidelines
For patients with mild narrowing of the subacromial space, a conservative, non-surgical approach is recommended as the first line of treatment, given the lack of clinically important improvement in pain, function, or quality of life with subacromial decompression surgery compared to other treatments 1. Mild narrowing of the subacromial space typically indicates early impingement syndrome in the shoulder. The condition occurs when the space between the acromion (part of the shoulder blade) and the humeral head narrows, causing compression of the rotator cuff tendons and bursa. Key aspects of conservative management include:
- Rest and avoiding activities that exacerbate the condition
- Applying ice for 15-20 minutes several times daily to reduce inflammation
- Using over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) for 1-2 weeks to reduce inflammation
- Initiating a structured physical therapy program focusing on rotator cuff strengthening and scapular stabilization exercises, typically 2-3 sessions weekly for 6-8 weeks
- Modifying activities that cause pain, particularly overhead movements Given the evidence from recent studies, such as the umbrella review of level 1 evidence published in the BMJ in 2021 1, which found that arthroscopic subacromial decompression did not provide clinically important improvement in pain, function, or quality of life compared to other treatments, surgical intervention should not be considered as an initial treatment option. If symptoms persist after 4-6 weeks of conservative management, further evaluation and consideration of other treatment options, such as corticosteroid injections, may be necessary. Early intervention with appropriate exercises and activity modification is crucial for preventing progression to more severe impingement, rotator cuff tears, or chronic shoulder dysfunction.
From the Research
Mild Narrowing of the Subacromial Space
- The subacromial space is a critical area in the shoulder joint, and its narrowing can lead to various shoulder conditions, including subacromial impingement/pain syndrome 2.
- This condition encompasses a spectrum of pathology of the subacromial bursa and rotator cuff tendons, and can be caused by repetitive overhead activity, inflammation, fibrotic changes, or partial- and full-thickness tears of the rotator cuff tendons 2.
- Studies have shown that the subacromial space volume significantly decreases in full-thickness rotator cuff tears smaller than 3 cm, and surgical repair can increase the subacromial volume significantly 3.
- Conservative physical therapy interventions, such as exercise therapy and manual therapy, can be effective in managing subacromial shoulder pain, with a strong recommendation for exercise therapy as the first-line treatment 4.
- The management of rotator cuff conditions depends on multiple factors, including chronicity, underlying anatomic and biomechanical factors, age, and the presence and degree of tendon tears, and may include physical therapy, anti-inflammatory drugs, injection therapies, or surgical repair 2.