From the Guidelines
Subacromial bursitis with impingement should be initially managed with conservative treatment, including NSAIDs, physical therapy, and rest, rather than immediate surgical intervention, as the current evidence suggests that surgery may not be more effective than non-operative care in many cases 1. The treatment of subacromial bursitis with impingement typically involves a combination of:
- NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily with food) for 1-2 weeks to reduce inflammation and pain
- Applying ice to the affected shoulder for 15-20 minutes every 2-3 hours during the first 48-72 hours
- Rest from overhead activities and those that cause pain, while avoiding complete immobilization
- Physical therapy focusing on rotator cuff strengthening and scapular stabilization exercises, typically involving 2-3 sessions weekly for 4-6 weeks Some studies suggest that corticosteroid injections, such as methylprednisolone 40mg with lidocaine, may be considered if symptoms persist after 2-3 weeks of conservative treatment 1. However, the evidence for the effectiveness of these injections is limited, and they should be used judiciously. It is essential to note that most cases of subacromial bursitis with impingement resolve with conservative treatment within 3-6 weeks, and persistent symptoms beyond 3 months may require further evaluation, including possible surgical intervention for subacromial decompression 1. Key considerations in the management of subacromial bursitis with impingement include:
- Avoiding unnecessary surgical interventions, which can be associated with significant morbidity and mortality 1
- Focusing on conservative treatment, including physical therapy and NSAIDs, to reduce inflammation and pain
- Considering corticosteroid injections or other interventions only if symptoms persist despite conservative treatment
- Evaluating the need for surgical intervention on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and response to conservative treatment.
From the Research
Subacromial Bursitis with Impingement
- Subacromial impingement syndrome (SAIS) is a common disorder of the shoulder, and the evidence for the effectiveness of treatment options is inconclusive and limited 2.
- Treatment options for SAIS include platelet-rich plasma (PRP) injection, corticosteroid injection, physical therapy, and exercise therapy 2, 3.
- Studies have shown that both PRP injection and exercise therapy are effective in reducing pain and disability in patients with SAIS, with exercise therapy proving more effective in the long term 2.
- Physical therapy and exercise have also been shown to be effective in improving shoulder function and reducing pain in patients with SAIS, with minimal adverse events 3, 4.
- Corticosteroid injections have been shown to provide short-term relief, but may require additional injections and have more adverse events compared to physical therapy 5.
Treatment Options
- Platelet-rich plasma (PRP) injection: effective in reducing pain and disability, but may not be as effective as exercise therapy in the long term 2, 3.
- Exercise therapy: effective in reducing pain and disability, and improving shoulder function, with minimal adverse events 2, 3, 4.
- Physical therapy: effective in improving shoulder function and reducing pain, with minimal adverse events 3, 4, 5.
- Corticosteroid injection: provides short-term relief, but may require additional injections and have more adverse events compared to physical therapy 3, 5.
Diagnosis and Management
- Subacromial impingement/pain syndrome is a common cause of shoulder pain, and encompasses a spectrum of pathology of the subacromial bursa and rotator cuff tendons 6.
- Diagnosis is typically made through clinical evaluation, and may be confirmed with imaging studies such as magnetic resonance imaging (MRI) or ultrasonography 6.
- Management depends on multiple factors, including chronicity, underlying anatomic and biomechanical factors, age, and the presence and degree of tendon tears, and typically starts with conservative care such as physical therapy, anti-inflammatory drugs, and injection therapies 6.