From the Guidelines
Subacromial bursitis is characterized by pain in the lateral shoulder, tenderness over the subacromial space, and pain with active shoulder abduction, as evidenced by physical exam findings and supported by studies such as 1. The condition typically presents with pain that radiates to the lateral arm, worsening with overhead activities and at night when lying on the affected side. Patients often report difficulty with activities like reaching, lifting, and combing hair. On physical examination, key findings include:
- Tenderness to palpation over the subacromial space, just beneath the acromion process
- Pain with active shoulder abduction between 60-120 degrees (painful arc)
- Passive range of motion is usually preserved but painful, while active motion may be limited due to pain
- Positive Neer impingement test and Hawkins-Kennedy test, which reproduce the pain
- A possible positive empty can test, suggesting rotator cuff involvement
- Swelling may be visible in severe cases, though this is uncommon
- Weakness may be present but is usually due to pain inhibition rather than true muscle weakness These findings help differentiate subacromial bursitis from other shoulder pathologies like rotator cuff tears or adhesive capsulitis, though they often coexist as part of subacromial impingement syndrome, as noted in studies like 1. The diagnosis can be further supported by imaging studies, with MRI and ultrasound being equivalent and usually appropriate for evaluation, as rated in 1.
From the Research
Signs and Symptoms of Subacromial Bursitis
- Pain and tenderness in the shoulder region, especially when lifting the arm or rotating it 2
- Limited range of motion and stiffness in the shoulder joint 2, 3
- Swelling and redness in the affected area, although this may not always be present 2
- Weakness in the shoulder muscles, making it difficult to perform daily activities 3, 4
Physical Exam Findings
- Tenderness to palpation over the subacromial bursa 2
- Painful arc of motion, especially when abducting the arm between 60-120 degrees 2, 3
- Weakness in shoulder abduction and external rotation 3, 4
- Decreased range of motion in the shoulder joint, especially in flexion, abduction, and external rotation 2, 3
Diagnostic Imaging
- Ultrasonography can be used to visualize the subacromial bursa and detect signs of bursitis, such as bursal thickening and effusion 2
- Magnetic resonance imaging (MRI) can also be used to evaluate the shoulder joint and surrounding tissues, although it is not always necessary for diagnosis 2
Treatment Options
- Subacromial corticosteroid injections can be effective in reducing pain and inflammation in patients with subacromial bursitis 5, 2
- Nonsteroidal anti-inflammatory drug (NSAID) injections can also be used as an alternative to corticosteroid injections, with similar efficacy and fewer side effects 3, 4, 6