Shoulder Bursitis as a Cause of Subacromial Pain and Limited Mobility
Yes, subacromial pain and limited shoulder mobility can absolutely be indicative of shoulder bursitis, specifically subacromial-subdeltoid bursitis, which is a common component of subacromial impingement syndrome and frequently presents with these exact symptoms. 1, 2
Clinical Presentation
Shoulder bursitis typically manifests with:
- Pain in the anterior or anterolateral shoulder that worsens with overhead activities (sensitivity 88%) 3
- Decreased range of motion, particularly during abduction with external or internal rotation 3
- Focal weakness in the affected shoulder (present in approximately 75% of patients) 3
- Positive Hawkins' test (highly sensitive at 92% but not specific at 25%) 3
- Positive Neer impingement sign (shoulder pain with passive abduction of the internally rotated arm) 4
Diagnostic Approach
Initial Imaging
Always obtain plain radiographs first to exclude bony abnormalities, fractures, calcific tendinitis, and acromial morphology issues. 1 Standard views include anteroposterior (internal and external rotation) and axillary or scapula-Y views. 1
Advanced Imaging When Radiographs Are Noncontributory
The American College of Radiology recommends two equally appropriate first-line options (both rated 9/9): 1
MRI without contrast: Advantageous for visualizing subacromial bursa inflammation, evaluating concurrent rotator cuff pathology, and assessing muscle atrophy and fatty infiltration (sensitivity 90%, specificity 80%) 1, 3
Ultrasound: Beneficial for real-time dynamic assessment, guiding therapeutic injection simultaneously, with no radiation and lower cost (sensitivity 85%, specificity 90% for rotator cuff abnormalities) 1, 3
The choice depends on local expertise availability. 1
When Infection Is Suspected
Perform bursal aspiration with ultrasound or fluoroscopic guidance (both rated 9/9). 1
Key Clinical Context
Subacromial-subdeltoid bursa effusion is frequently associated with shoulder pain, often independently from underlying pathology. 5 In a large ultrasonographic study of 1147 shoulders, effusion in the subacromial-subdeltoid bursa showed statistically significant associations (p<0.01) with: 5
- Acromioclavicular joint arthritis
- Supraspinatus tendon calcific tendinopathy
- Full-thickness and superficial tears of the supraspinatus
- Trauma
- Rheumatoid arthritis
Important Distinction
Subacromial impingement/pain syndrome encompasses a spectrum of pathology including both subacromial bursa inflammation and rotator cuff tendon pathology. 2 These conditions frequently coexist, so identifying bursitis doesn't exclude other concurrent shoulder pathology. 5
Common Pitfall
Don't assume bursitis is the sole diagnosis. Approximately one-third of patients with shoulder pain have multiple pathologies on ultrasound (30.4% have two pathologies, 4.1% have three). 5 The presence of bursal effusion often indicates underlying structural problems that require identification and treatment. 5