Subacromial Bursitis

Definition

Subacromial bursitis is inflammation of the bursa located beneath the acromion, and is a very frequent shoulder complaint seen in general practice. Orthopaedic surgeons call it the impingement syndrome of the shoulder.

Aetiology

Apart from trauma, the cause of subacromial bursitis is not always clear. Segmental dysfunctions of the cervical spine and cervicothoracic junction may play a role in the clinical picture. Therefore, in addition to evaluation of shoulder function, it is very important to examine the cervical spine as well.

Signs and symptoms

In general, the symptoms are characterised by shoulder pain that increases after each time it takes a load, with shoulder abduction of over 90°. Nocturnal pain and the inability to sleep on the affected shoulder point in the direction of an inflammation.

The location and radiation pattern of the pain can provide information on whether it is caused by a primary pathology of the shoulder, or that it is located outside the shoulder.

In particular, in non-traumatic shoulder pain with an abnormal natural course, other serious diseases, such as generalised joint pain, fever, malaise, weight loss, dyspnoea and angina pectoris, should be explored. Most importantly, a pancoast tumour must be excluded.

Diagnostics

Physical Examination

Examination of the shoulder in subacromial bursitis:

Three groups of shoulder tests are important in examination of the shoulder: 1. active and passive shoulder abduction; 2. active and passive shoulder external rotation; and 3. active and passive horizontal shoulder adduction. Serious shoulder pathology, presenting as brachialgia, can be diagnosed by means of these tests.

In addition, it is important to perform passive shoulder abduction in external rotation. Passive abduction should be performed as often as possible in the frontal plane.

 

The table below lists the impingement syndromes that have the same clinical findings as subacromial bursitis.

DISORDER

Passive External

Rotation restriction

Active Abduction restriction
in
Neutral Position Arm

Passive Abduction restriction
in
External Rotation Position Arm

Passive Horizontal Abduction restriction

Impingement Syndrome

-

+++

-

-

Subabcromial Bursitis

-

+++

-

-

Additional Somatic Diagnostics

  • In the initial phase of uncomplicated shoulder complaints, no imaging techniques or laboratory examinations are indicated.
  • When systemic diseases or other serious conditions are suspected in shoulder pain, blood tests are indicated (CRP, Hb, BSE, rheumatoid factors).
  • When shoulder pain persists, X-ray, ultrasound and MRI scan are indicated.
  • A bone scan is indicated if there is any suspicion of metastases or primary tumours.

Somatic Treatment

Pharmacological treatment:

Other Treatments

Interventional Pain Treatment

When the injection is performed correctly, pain-free passive shoulder abduction should be present immediately following this injection. In addition, in case of temporarily effect, referral to an orthopaedic surgeon is indicated.