From the Guidelines
Subacromial bursitis is best diagnosed through a combination of clinical examination and imaging studies, and treatment should prioritize conservative measures, including rest, ice, NSAIDs, and physical therapy, with corticosteroid injections considered for persistent symptoms, as supported by the most recent evidence 1.
Diagnosis
Diagnosis of subacromial bursitis typically involves assessing for pain with overhead movement, tenderness at the lateral shoulder, and a positive impingement sign. Ultrasound or MRI may confirm the diagnosis by showing fluid accumulation in the bursa and ruling out rotator cuff tears.
Treatment
Treatment begins with conservative measures, including:
- Rest
- Ice application for 15-20 minutes several times daily
- NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and pain Physical therapy focusing on gentle stretching and strengthening exercises for the rotator cuff muscles is essential for recovery and preventing recurrence.
Persistent Symptoms
For persistent symptoms, a corticosteroid injection (such as 40mg methylprednisolone with lidocaine) into the subacromial space may provide relief, as suggested by earlier studies 1.
Surgical Intervention
Most patients improve with conservative measures within 4-6 weeks, but if conservative treatment fails after 3-6 months, surgical intervention through arthroscopic bursectomy may be considered, although recent evidence highlights the importance of prioritizing non-surgical interventions and carefully considering the effectiveness of surgical procedures 1.
Causes
The condition often results from repetitive overhead activities causing friction between the acromion and rotator cuff tendons, leading to inflammation of the bursa that normally facilitates smooth movement between these structures.
From the FDA Drug Label
The area around the injection site is prepared in a sterile way and a wheal at the site made with 1 percent procaine hydrochloride solution. A 20 to 24 gauge needle attached to a dry syringe is inserted into the bursa and the fluid aspirated. The needle is left in place and the aspirating syringe changed for a small syringe containing the desired dose After injection, the needle is withdrawn and a small dressing applied. In the treatment of conditions such as tendinitis or tenosynovitis, care should be taken following application of a suitable antiseptic to the overlying skin to inject the suspension into the tendon sheath rather than into the substance of the tendon The dose in the treatment of the various conditions of the tendinous or bursal structures listed above varies with the condition being treated and ranges from 4 to 30 mg
Diagnosis and Treatment of Subacromion Bursitis:
- The diagnosis is not explicitly stated in the provided drug labels, but the treatment for bursitis is described.
- The treatment involves injecting a corticosteroid, such as methylprednisolone or triamcinolone, into the bursa.
- The dose of methylprednisolone for bursitis ranges from 4 to 30 mg 2.
- The dose of triamcinolone for bursitis is not explicitly stated for this specific condition, but the general dose range for local injections is 2.5 mg to 5 mg for smaller joints and from 5 mg to 15 mg for larger joints 3.
- It is essential to follow strict aseptic technique and inject the suspension into the bursa, rather than the surrounding tissue, to avoid tissue atrophy.
From the Research
Diagnosis of Subacromial Bursitis
- The diagnosis of subacromial bursitis, also known as subacromial pain syndrome (SAPS), can be made using a combination of clinical tests 4.
- Magnetic resonance imaging (MRI) study and ultrasonography may be useful to evaluate for soft tissue pathology, depending on the level of clinical concern regarding rotator cuff tear 5.
- Diagnostic imaging is useful after 6 weeks of symptoms, with ultrasound examination being the recommended imaging to exclude a rotator cuff rupture 4.
Treatment of Subacromial Bursitis
- The treatment of subacromial bursitis typically starts with conservative care such as physical therapy, anti-inflammatory drugs, and injection therapies 5.
- Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms 4.
- Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered 4.
- Corticosteroid subdeltoid injection, or combined with physiotherapy, was superior to physiotherapy alone, but the recurrence rate was least in the physiotherapy group 6.
- Ultrasound (US) guided local corticosteroid injection is a technique that can be used to treat subacromial bursitis, with the main advantage being the possibility to identify vascular structures, nerves and tendons situated in the needle path in order to avoid these structures and be sure to inject the drug into the appropriate location 7.
Pharmaceutical Interventions
- Moderate evidence was found in favor of immediate release oral ibuprofen compared with sustained-released ibuprofen in the short-term 8.
- Moderate evidence for effectiveness was found in favor of glyceryltrinitrate patches versus placebo patches in the short-term and mid term 8.
- Injections with disodium ethylene diamine tetraacetic acid plus ultrasound with ethylene diamine tetraacetic acid gel were more effective (moderate evidence) than was placebo treatment in the short- and long-term 8.