Is massage beneficial for subacromial bursitis?

Massage for Subacromial Bursitis

Massage therapy is not recommended for subacromial bursitis as it has not demonstrated benefit for this specific condition and may potentially worsen symptoms. 1

Evidence Against Massage for Subacromial Bursitis

• The American College of Rheumatology/Arthritis Foundation conditionally recommends against massage therapy for shoulder conditions, noting that studies have suffered from high risk of bias, included small numbers of patients, and have not demonstrated benefit for specific outcomes 1
• While some patients report subjective benefits from massage, the available evidence specifically regarding subacromial conditions does not support its use for reducing symptoms 1
• Manual therapy techniques (which include massage) combined with exercise are conditionally recommended against over exercise alone for shoulder conditions 1

Recommended First-Line Treatments for Subacromial Bursitis

Non-Pharmacological Approaches:

• Therapeutic exercises focusing on strengthening weak muscles in the shoulder girdle and gradually increasing range of motion are recommended as first-line treatment 1, 2
• Gentle stretching and mobilization techniques, typically involving increasing external rotation and abduction, are recommended for shoulder pain 1
• Thermal interventions (locally applied heat or cold) are conditionally recommended for shoulder pain 1, 2

Pharmacological Approaches:

• NSAIDs are recommended alongside exercises as initial treatment for subacromial impingement syndrome 2
• If there are no contraindications, analgesics such as acetaminophen or ibuprofen can be used for pain relief 1
• Subacromial corticosteroid injections can be used when pain is thought to be related to inflammation of the subacromial region (rotator cuff or bursa) 1, 3
  • Ultrasound-guided corticosteroid injection has been proven effective and superior to hyaluronic acid and normal saline injection for treating chronic subacromial bursitis 3

Treatment Algorithm

1. Initial Treatment (0-6 weeks):

   • Therapeutic exercises and NSAIDs as first-line treatment 2
   • Application of thermal interventions (heat or cold) 1

2. If Inadequate Response (6-12 weeks):

   • Consider subacromial corticosteroid injection 1, 3
   • Continue with progressive therapeutic exercises 2

3. For Persistent Symptoms (>3 months):

   • Re-evaluation for other potential causes 2
   • Consider referral for surgical evaluation if conservative measures fail, though evidence does not clearly support surgical benefits over continued conservative treatment 1, 2

Important Considerations and Cautions

• Massage may have benefits for general well-being but lacks evidence specifically for subacromial bursitis treatment 1
• Subacromial corticosteroid injections, while effective, should be used judiciously due to potential complications including infection (rare but serious cases of methicillin-resistant Staphylococcus aureus have been reported) 4
• Botulinum toxin type B injections may be considered as an alternative to corticosteroid injections, with some evidence suggesting better long-term outcomes at 3 months 5
• The American Academy of Orthopaedic Surgeons recommends a 3-6 month period of conservative treatment before considering surgical options 2