MANUAL MINORS
Subacromial bursitis is the inflammation of the subacromial bursa, a small fluid-filled sac that acts as a cushion between the acromion (part of the scapula) and the rotator cuff tendons in the shoulder.
This condition can be caused by overuse, repetitive shoulder movements, trauma, or inflammatory diseases like rheumatoid arthritis. Inflammation of the bursa leads to shoulder pain, particularly when lifting the arm, and may limit movement if left untreated.
Diagnosis
Diagnosis is based on the presence of pain in the lateral or superior part of the shoulder, especially when raising the arm or performing overhead movements. Pain is often worse at night or after physical activity. During physical examination, tests like Neer’s and Hawkins’ reproduce pain by compressing the bursa.
Ultrasound or magnetic resonance imaging (MRI) can be useful to visualise the inflamed bursa and rule out other conditions, such as rotator cuff tears or impingement syndrome.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Impingement syndrome | Pain with overhead movements, associated with compression of the rotator cuff |
Rotator cuff tear | Acute pain with significant weakness when raising the arm |
Bicipital tendinitis | Pain in the front of the shoulder, associated with arm flexion and supination |
Adhesive capsulitis (frozen shoulder) | Severe shoulder pain and stiffness, with limitation in all ranges of motion |
Shoulder osteoarthritis | Chronic pain, progressive stiffness, and decreased range of motion |
Emergency Management
Initial emergency management includes the use of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. Ice application during the first 48 hours can be helpful. If pain is severe, a corticosteroid injection into the subacromial bursa may provide rapid and effective relief.
Painful movements, particularly overhead activities, should be limited. In acute cases, a temporary sling may be used to immobilise the shoulder.
Definitive Treatment
Definitive treatment is typically conservative and includes physiotherapy to improve range of motion and strengthen the rotator cuff muscles. The goal is to reduce pressure on the bursa and prevent recurrence.
In chronic or recurrent cases that do not respond to conservative treatment, arthroscopic surgery may be considered to remove the inflamed bursa or address any underlying issues, such as osteophytes or subacromial impingement. Postoperative rehabilitation is essential to restore shoulder function and prevent complications.
Comments