Symptoms of Shoulder Bursitis
Shoulder bursitis typically presents with pain and tenderness localized to the affected bursa, most commonly the subacromial-subdeltoid region, with pain often worsening during overhead activities or specific shoulder movements.
Primary Clinical Manifestations
Pain Characteristics
- Localized pain and tenderness over the affected bursa, particularly the subacromial region, is the hallmark symptom 1
- Pain typically worsens with overhead activities and movements that compress the inflamed bursa 2
- The pain may be activity-related and improve with rest and activity modification 3
Associated Physical Findings
- Limited range of motion in the shoulder, particularly with abduction and external rotation movements 4
- Swelling may be present over the affected area, though this is less common in deeper bursae like the subacromial bursa 4
- Tenderness to palpation over the lateral aspect of the shoulder and proximal humerus region 5
Important Clinical Distinctions
What Bursitis Is NOT
- Weakness and muscle atrophy are uncommon in isolated bursitis and suggest alternative diagnoses such as rotator cuff pathology 5
- Bursitis must be distinguished from arthritis, fracture, tendinitis, and nerve pathology through careful clinical examination 3
- Unlike rotator cuff tendinopathy, bursitis does not typically present with focal weakness during specific resistance testing 5
Chronic vs. Acute Presentations
- Acute bursitis presents with more pronounced pain and may have associated inflammatory signs 3
- Chronic bursitis involves persistent pain without acute inflammation, often related to repetitive mechanical stress 2
- In rare cases, particularly in immunocompromised patients or those with rheumatoid arthritis, bursitis may present with systemic symptoms if infection or severe inflammation is present 6
Critical Diagnostic Pitfalls
Overlapping Conditions
- Shoulder bursitis frequently coexists with rotator cuff pathology, making isolated diagnosis challenging 2
- The American Academy of Family Physicians notes that chronic tendinopathy involves collagen disorientation rather than acute inflammation, meaning symptoms attributed to "bursitis" may actually represent underlying tendon degeneration 2
- External rotation limitation is particularly significant and often neglected in assessment, yet relates most significantly to persistent shoulder pain 2
Red Flags Requiring Further Investigation
- Severe, unremitting pain that doesn't respond to conservative measures may indicate septic bursitis or other serious pathology 3
- Night pain and rest pain are atypical for simple bursitis and warrant imaging to exclude rotator cuff tears or other structural pathology 2
- Presence of systemic symptoms (fever, malaise) suggests septic bursitis requiring urgent evaluation 3
Functional Impact
- Shoulder pain from bursitis can delay rehabilitation and functional recovery in patients undergoing treatment for other conditions 4, 7
- The condition may contribute to depression, sleeplessness, and reduced quality of life when chronic 4
- Patients often report difficulty with activities of daily living requiring overhead reach or shoulder abduction 7