What’s subacromial bursitis?

Subacromial bursitis is an inflammatory condition that is a common cause of shoulder pain. It is commonly caused by repetitive overhead activities and minor trauma such as falls.

Common etiologies include:

Subacromial impingement
Repetitive overhead activities /overuse
Direct trauma
Crystal deposition
Subacromial haemorrhage
Infection
Autoimmune diseases (eg: rheumatoid arthritis)

Epidemiology

Bursitis accounts for approximately 0.4% of all primary care visits. Gender prevalence is equal. It is often seen in individuals who participate in repetitive overhead activities such as athletes, factory workers and manual labourers. Older individuals are prone due to years of wear leading to increase in impingement.

Diagnosis

A thorough history and physical is of vital importance to diagnose subacromial bursitis. It usually presents with pain in the anterolateral aspect of the shoulder. Patients may report sustaining trauma such as fall with direct impact to the shoulder or a history of repetitive overhead activities such as overhead sports, lifting boxes, etc .on physical examination, the patient will have point of tenderness at the anterolateral aspect of the shoulder below the acromion. The pain is localised and typically doesn’t radiate to other parts of the shoulder or thearm.

Treatment and management

Nonoperative treatment is the usual treatment route for subacromial bursitis. Treatment modalitites include: Rest and Non-steroidal anti-inflammatory medications(NSAIDs) in the acute phase for 1 or 2 weeks Corticosteroid injections may be used for severe pain in the first 8 weeks Use of high-energy ESWT can be considered for proven subacromial calcium deposits
Physical therapy : 1-movements within the pain threshold is desirable 2- Neither strict immobilisation nor passive joint mobilisation 3- Exercise should be performed at low intensity and high frequency withinpain threshold focusing on eccentric training 4- Scapular stabilisation training and relaxation with proper posture 5- Treatment of Myofascial trigger points (including stretching of the muscles) 6- Rehabilitation can be considered for chronic phase

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