Symptoms of Subacromial Bursitis or Rotator Cuff Tendinitis
The primary symptoms of subacromial bursitis or rotator cuff tendinitis include pain that radiates down the upper arm, pain at night, limitation of motion, and weakness in the affected shoulder. 1
Common Symptoms
Pain Characteristics
- Pain that radiates down the upper arm
- Night pain, often disturbing sleep
- Pain with overhead activities
- Pain at rest (in more severe cases)
- Pain with specific movements, particularly:
- Internal rotation (positive Hawkins' test)
- Forward flexion between 70-120 degrees (positive Neer's test) 2
Functional Limitations
- Limited range of motion, especially with overhead activities
- Weakness on abduction and external rotation
- Difficulty with daily activities requiring arm elevation
- Pain that worsens with repetitive overhead movements 2
Physical Examination Findings
- Tenderness over the subacromial area
- Deltoid and rotator cuff muscle atrophy (in chronic cases)
- Positive impingement tests:
- Hawkins' test (92% sensitive, 25% specific)
- Neer's test (88% sensitive, 33% specific) 2
- Weakness in shoulder abduction and external rotation 1
Pathophysiology and Risk Factors
Mechanism of Injury
- Repeated impingement of the coracoacromial arch onto the supraspinatus tendon
- Hypovascularity in the region proximal to the supraspinatus tendon insertion
- Biomechanical dysfunction of the rotator cuff and glenohumeral complex 2, 3
Risk Factors
- Age over 40 years (rotator cuff degeneration increases with age)
- Repetitive overhead activities
- Athletes who throw repetitively
- Occupations requiring overhead work
- Previous shoulder injuries 2
Clinical Course and Progression
The clinical presentation often follows a pattern:
- Initial inflammation of the subacromial bursa and/or rotator cuff tendons
- Progression to fibrotic changes in the tendons if untreated
- Potential development of partial or full-thickness tears with continued stress 3, 4
Diagnostic Considerations
In patients with suspected subacromial bursitis or rotator cuff tendinitis, physical examination may reveal:
- Positive impingement signs (Hawkins' and Neer's tests)
- Pain with active and resisted movements
- Limited range of motion
- Muscle weakness 2, 5
Important Distinctions
It's important to note that while subacromial bursitis and rotator cuff tendinitis often coexist and share similar symptoms, they represent different pathological processes:
- Subacromial bursitis: Inflammation of the bursa that cushions the rotator cuff tendons
- Rotator cuff tendinitis: Inflammation or degeneration of the rotator cuff tendons themselves 4
In many cases, these conditions occur together as part of the subacromial impingement syndrome, which encompasses a spectrum of pathology involving both the subacromial bursa and rotator cuff tendons 3.