Subacromial pain syndrome (SAPS) describes shoulder pain arising from the structures between the coracoacromial arch and the rotator cuff. It is the modern UK umbrella term covering subacromial bursitis, rotator cuff tendinopathy, and partial-thickness cuff tears, framed by BESS 2025 as a spectrum of rotator cuff-related shoulder pain (RCRSP) rather than discrete diagnoses. Most common in adults aged 40-60 and in occupations involving sustained overhead work.
The subacromial space sits between the coracoacromial arch above and the rotator cuff below. The subacromial-subdeltoid bursa is a synovial-lined sac in this space that reduces friction between the cuff (primarily supraspinatus) and the overlying acromion and deltoid. It does not normally communicate with the glenohumeral joint.
SAPS is now understood as a degenerative-reactive process of the cuff and bursa, not simple mechanical impingement. Bursitis is usually secondary to underlying cuff tendinopathy, partial cuff tear, or calcific tendinopathy. Less common drivers include traumatic haemorrhagic bursitis, overuse from repetitive overhead activity, crystal deposition (gout, pseudogout), and rare septic bursitis (Staphylococcus aureus; risk factors include diabetes and immunosuppression). BESS 2025 frames bursitis as part of the RCRSP spectrum rather than a separate diagnostic entity.
Risk factors: age 40-60, repetitive overhead activity, rotator cuff tendinopathy, calcific tendinopathy, diabetes, rheumatoid arthritis, immunosuppression (for septic bursitis).
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