From the Guidelines
Subacromial bursitis typically presents with pain and tenderness over the lateral shoulder, and while it can radiate to other areas, sudden pain directly under the clavicle is not a classic presentation and may suggest alternative diagnoses.
Presentation of Subacromial Bursitis
Subacromial bursitis usually causes pain and tenderness over the lateral shoulder that worsens with overhead activities and may cause night pain when lying on the affected side. The pain can occasionally radiate to the deltoid region or upper arm. However, pain directly under the clavicle is not a typical presentation of subacromial bursitis and may indicate other conditions such as acromioclavicular joint pathology or cervical radiculopathy 1.
Diagnostic Tools for Subacromial Bursitis
Ultrasound is a useful diagnostic tool for subacromial bursitis, offering real-time visualization of bursal thickening, fluid accumulation, and potential rotator cuff pathology. It is non-invasive, relatively inexpensive, and allows dynamic assessment of shoulder movement. According to the American College of Radiology, ultrasound is equivalent to MRI in the evaluation of subacromial bursitis, especially when local expertise is available 1. Ultrasound can also guide injections and aspirations, aiding in both diagnosis and treatment of shoulder pain.
Management of Subacromial Bursitis
Patients with suspected subacromial bursitis should rest the shoulder, use ice for 15-20 minutes several times daily, and take NSAIDs like ibuprofen for pain and inflammation. Consideration of physical therapy focusing on rotator cuff strengthening and scapular stabilization is also recommended. If conservative measures fail, a subacromial corticosteroid injection may be administered, often under ultrasound guidance for precision 1. The condition results from inflammation of the subacromial bursa, usually due to repetitive overhead activities, shoulder impingement, or rotator cuff tendinopathy.
Key Points
- Subacromial bursitis presents with lateral shoulder pain, not typically directly under the clavicle.
- Ultrasound is a valuable diagnostic tool, equivalent to MRI in many cases.
- Management includes rest, ice, NSAIDs, physical therapy, and potentially corticosteroid injections under ultrasound guidance.
From the Research
Presentation of Subacromial Bursitis
- Subacromial bursitis can present with shoulder pain, which may be sudden or gradual in onset 2
- The pain is often located in the lateral aspect of the shoulder, but it can also radiate to the upper arm or be felt under the clavicle 3
- Other symptoms may include limited range of motion, weakness, and stiffness in the shoulder joint 4
Sudden Pain Under the Clavicle
- Sudden pain under the clavicle can be a symptom of subacromial bursitis, especially if it is associated with other symptoms such as limited range of motion or weakness in the shoulder joint 2
- However, sudden pain under the clavicle can also be caused by other conditions, such as acromioclavicular joint arthritis or rotator cuff tears 3
Ultrasound as a Diagnostic Tool
- Ultrasound is a useful diagnostic tool for evaluating subacromial bursitis, as it can detect bursal thickening and effusion 4, 5
- Ultrasound can also be used to evaluate the rotator cuff tendons and other soft tissue structures in the shoulder joint 2
- The use of ultrasound can help guide injections and other treatments, and can also be used to monitor the response to treatment 4
Key Findings
- Studies have shown that subacromial bursitis is a common cause of shoulder pain, and that ultrasound is a useful tool for diagnosing and managing this condition 6, 3
- The presence of bursal effusion and thickening on ultrasound can be associated with shoulder pain and limited range of motion 5
- Further studies are needed to fully understand the relationship between subacromial bursitis and shoulder pain, and to develop effective treatment strategies for this condition 3