Subacromial bursitis

Background

Shoulder bursa.

Shoulder anatomy, anterior.

• Inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-acromial ligament, acromion, coracoid (the acromial arch) and from the deep surface of the deltoid muscle
• The subacromial bursa helps the motion of the supraspinatus tendon of the rotator cuff in activities such as overhead work.
• Commonly occurs in individuals who participate in repetitive overhead activities (athletes, manual laborers, and factory workers)

Clinical Features

• Point tenderness at the anterolateral aspect of the shoulder below the acromion
• Pain with abduction of arm between 60-120 degrees

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

• Shoulder Dislocation
  • Anterior shoulder dislocation
  • Posterior shoulder dislocation
  • Inferior shoulder dislocation
• Clavicle fracture
• Humerus fracture
• Scapula fracture
• Acromioclavicular joint injury
• Glenohumeral instability
• Rotator cuff tear
• Biceps tendon rupture
• Triceps tendon rupture
• Septic joint

Nontraumatic/Chronic:

• Rotator cuff tear
• Impingement syndrome
• Calcific tendinitis
• Adhesive capsulitis
• Biceps tendinitis
• Subacromial bursitis
• Cervical radiculopathy

Refered pain & non-orthopedic causes:

• Referred pain from
  • Neck
  • Diaphragm (e.g. gallbladder disease)
• Brachial plexus injury
  • Rucksack paralysis
• Axillary artery thrombosis
• Thoracic outlet syndrome
• Subclavian steal syndrome
• Pancoast tumor
• Myocardial infarction
• Pneumonia
• Pulmonary embolism

Evaluation

Workup

• Labs
  • Not usually indicated
  • Consider synovial fluid analysis if concern for septic arthritis
• Imaging
  • Not necessary for diagnosis
  • Ultrasound may be helpful in measuring thickness of subacromial bursa
  • Consider shoulder X-ray to rule out fractures, dislocations, osteoarthritis, etc.

Diagnosis

• Typically a clinical diagnosis

Management

• Non-operative management
  • Rest, cold/heat, NSAIDs
  • (+/-) Corticosteroid injection

Disposition

• Most patients can be discharged and treated outpatient
• Consider admission if overlying cellulitis, signs of sepsis, or unable to tolerate pain

See Also

• Bursitis
• Rotator cuff tear

External Links

• Physiopedia - Shoulder Bursitis