Treatment of Deltoid Bursitis
Deltoid bursitis should be treated conservatively with rest, ice, NSAIDs, and activity modification as first-line therapy, reserving corticosteroid injections for refractory cases and avoiding complete immobilization to prevent muscle atrophy. 1
Initial Conservative Management
Rest and activity modification are fundamental, allowing patients to continue activities that do not worsen pain while avoiding complete immobilization to prevent muscular atrophy and deconditioning 1
Cryotherapy should be applied through a wet towel for 10-minute periods to reduce swelling and provide short-term pain relief by reducing tissue metabolism and blunting the inflammatory response 1
NSAIDs effectively relieve tendinopathy and bursitis pain, with topical formulations eliminating the gastrointestinal hemorrhage risk associated with systemic NSAIDs 1
Physical therapy emphasizing therapeutic exercise and stretching is widely accepted, as tensile loading stimulates collagen production and guides normal alignment of newly formed collagen fibers 1
Treatment Escalation for Refractory Cases
Corticosteroid injections may be considered for chronic inflammatory bursitis when conservative measures fail after 6-8 weeks, though this remains a topic of debate requiring more research regarding optimal drugs, dosages, and techniques 1
Immobilization may be considered in particularly acute or refractory cases, though prolonged immobilization should be avoided 1
Bursa aspiration is generally not recommended for microtraumatic bursitis due to the risk of iatrogenic septic bursitis, but should be performed if infection is suspected with fluid examined using Gram stain, crystal analysis, glucose measurement, blood cell count, and culture 2
Critical Diagnostic Considerations
Rule out septic bursitis through clinical assessment focusing on signs of infection; if suspected, bursal aspiration is mandatory before initiating treatment 2
Ultrasonography can help distinguish bursitis from cellulitis and demonstrate tendon thickening and heterogeneous echogenicity 1, 2
Blood testing (white blood cell count, inflammatory markers) and MRI can help distinguish infectious from noninfectious causes when the diagnosis remains unclear 2
Evidence-Based Treatment Outcomes
Recent high-quality evidence demonstrates that corticosteroid subdeltoid injection produces superior short-term pain relief compared to physiotherapy alone, but physiotherapy has the lowest recurrence rate (7.5% vs 36.1% for corticosteroid injection alone) 3. Combined treatment showed intermediate recurrence rates at 17.1% 3.
Common Pitfalls to Avoid
Avoid overhead pulleys which encourage uncontrolled abduction and may worsen symptoms 1
Do not inject corticosteroids directly into tendons as this can adversely affect biomechanical properties, particularly near the rotator cuff insertion 1, 4
Address underlying causes such as repetitive microtrauma, glenohumeral joint dysfunction, or postural abnormalities to prevent recurrence 5