What is the management of right shoulder bursitis?

Management of Right Shoulder Bursitis

The management of right shoulder bursitis should include a combination of conservative measures first, followed by corticosteroid injections if needed, with physical therapy focusing on range of motion and strengthening exercises as the cornerstone of treatment. 1, 2

Initial Conservative Management

• Rest and activity modification to avoid movements that exacerbate pain 2
• NSAIDs such as naproxen (starting dose 500mg followed by 250mg every 6-8 hours as needed) for pain and inflammation 3
• Application of ice or heat for symptomatic relief before exercise 2
• Gentle stretching and mobilization techniques focusing especially on external rotation and abduction to prevent frozen shoulder 1
• Soft tissue massage to reduce pain and improve tissue elasticity 1

Physical Therapy Interventions

• Active, active-assisted, or passive range of motion exercises to maintain and improve shoulder mobility 2
• Avoid overhead pulleys which encourage uncontrolled abduction and may worsen pain 1
• Gradually increase active range of motion while restoring alignment and strengthening weak muscles in the shoulder girdle 2
• Electrical stimulation may be beneficial to improve shoulder lateral rotation 1
• Shoulder strapping (sling) can be used for protection and pain relief 1

Pharmacological Management

First-line

• Oral NSAIDs like naproxen for pain control and reducing inflammation 3
• Topical NSAIDs can be considered for mild to moderate pain with fewer systemic side effects 2

Second-line

• Intra-articular corticosteroid injections (triamcinolone acetonide) when conservative measures fail 1, 4
• For shoulder bursitis, 5-15 mg of triamcinolone can be injected into the subacromial bursa 4
• Injections should be performed with strict aseptic technique to prevent infection 4

Corticosteroid Injection Technique

• Position the patient appropriately to access the subacromial space 4
• Use aseptic technique with skin preparation 4
• Consider using ultrasound guidance to ensure accurate placement 4
• Inject 5-15 mg of triamcinolone acetonide (dosage depends on the size of the joint/bursa) 4
• Avoid repeated injections as they may lead to tendon weakening 4

Monitoring and Follow-up

• Reassess response to treatment regularly 2
• If symptoms persist despite conservative treatment and injections for more than 3-6 months, consider referral for surgical evaluation 5
• Monitor for symptom recurrence, which is less common with comprehensive physical therapy (7.5%) compared to corticosteroid injections alone (36.1%) 6

Treatment Algorithm

1. Start with conservative measures (rest, NSAIDs, ice/heat) for 2-4 weeks 2, 3
2. Initiate physical therapy focusing on range of motion and strengthening exercises 1, 2
3. If inadequate response after 4-6 weeks, consider corticosteroid injection 1, 4
4. Continue physical therapy after injection to maintain gains and prevent recurrence 6
5. For refractory cases not responding to 2-3 months of combined therapy, consider surgical consultation 5

Important Considerations

• Shoulder pain can delay rehabilitation and functional recovery 1
• Combined treatment (corticosteroid injection plus physical therapy) shows better outcomes than either treatment alone, with lower recurrence rates than injections alone 6
• Avoid repeated corticosteroid injections as they may lead to tendon weakening and tissue atrophy 4
• Staff education about proper handling and positioning of the affected shoulder is important to prevent further injury 1