Patients with subacromial bursitis often present with a history of trauma, inflammatory joint diseases such as SLE, gout, and rheumatoid athritis, or repetitive movement of the shoulder over the head from sporting or work-related activities.

Subacromial bursitis presents with localized tenderness over the greater tubercle of the humerus and over the shoulder, erythema of the skin over both areas, local edema, and reduced range of motion particularly abduction. The inflammation also presents with warmth of the skin overlying the bursa.

Chronic bursitis results in disuse of the shoulder leading to atrophy and weakness of the ligaments and muscles of the shoulder joint. Physical examination may be used to distinguish bursitis from other musculoskeletal diseases: a reduction in both active and passive range of motion suggests musculoskeletal diseases and not bursitis. In bursitis, passive range of motion is intact.

• Pain

  The pre- and postinjection within-group comparison revealed significant improvement in the visual analog scale for pain and range of motion, as well as in the Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, and SF-36 scores, in [ncbi.nlm.nih.gov]

  The onset of pain may be sudden or gradual and may or may not be related to trauma. Night time pain, especially sleeping on the affected shoulder, is often reported. [en.wikipedia.org]

  Directly massaging an inflamed bursa will cause more pain. Question: How many types of bursitis of the shoulder are there? Answer: Two. Acute bursitis is very painful and generally lasts six to eight weeks. [massagetoday.com]

  […] by a physiotherapist, and use of over-the-counter pain killers. [symptoma.com]

• Inflammation

  Subacromial bursitis refers to an inflammation of the subacromial bursa. [symptoma.com]

  Although further investigation is required, these studies suggest that inflammation of the subacromial bursa does occur in patients with rotator cuff disease. [ncbi.nlm.nih.gov]

  […] by shoulder tendonitis or commonly known as inflammation of the shoulder tendons (supraspinatus or biceps tendon). [khpoon.com]

  Stage 1: To reduce the pain and inflammation. Apply cold therapy or ice to the shoulder. This will help reduce pain and inflammation. [sportsinjuryclinic.net]

• Swelling

  A patient with rheumatoid arthritis was seen whose main complaint was marked swelling of the shoulders. Surgical exploration revealed the swelling to be secondary to subacromial bursitis; the glenohumeral joint appeared normal. [ncbi.nlm.nih.gov]

  It can cause swelling and stiffness and the shoulder may also be warm and red. [painsolutions.org.uk]

  Bursitis is inflammation and swelling of the bursa. The injury can be secondary to trauma to the shoulder e.g. a fall or contact in a tackle, or repetitive micro trauma e.g. excessive throwing/reaching above the head. [spinalandsportscare.com.au]

  Overview This condition is a swelling of the subacromial bursa, a fluid-filled sac that creates a cushion between the acromion and the head of the humerus. Causes This condition is typically caused by excessive use of the shoulder. [centralcoastortho.com]

• Weakness

  Complete rotator cuff tears result in acute pain and weakness of the shoulder. In larger tears of the rotator cuff, weakness of external rotation is particularly apparent. [msdmanuals.com]

  The patient complains of pain in the shoulder on anterior and lateral aspect and may be associated with weakness and stiffness. Weakness without pain may suggest rotator cuff tear or suprascapular nerve compression. [boneandspine.com]

  Pain along the front and side of the shoulder is the most common symptom and may cause weakness and stiffness. [en.wikipedia.org]

• Arm Pain

  Result of an injury: falling onto outstretched hand or elbow Shoulder Impingement symptoms Shoulder Impingement may have the following symptoms: Pain, present with activity and/or rest Pain radiating from the front of the shoulder to the side of the arm [shouldersurgery.com.au]

  The pain starts as you lift the arm and continues to a point but then disappears as the arm reaches a full overhead position. [wocwa.com.au]

  For example, patients frequently refer to the upper border of the trapezius and the scapula as their “shoulder”; 7 pain here has different diagnoses from pain localised to the shoulder or lateral upper arm. [mja.com.au]

  The quality of pain was dull and of an aching kind. The site of pain was reported as aching pain around the shoulder and down the same arm but not below the elbow, as shown in [Figure 1]. [indianjpain.org]

• Diarrhea

  No statistically significant differences in adverse events were noted between groups, but subjects who received rilonacept experienced more episodes of diarrhea and headache. [ncbi.nlm.nih.gov]

  […] dermatitis 【アナフィラキシー】*anaphylaxis 【アフタ】*aphtha (形 *aphthous) 【アフタ性咽頭炎】*aphthous pharyngitis 【アフタ性潰瘍】 *aphthous ulcer 【アフタ性口内炎】 *aphthous stomatitis 【アフタ性歯肉炎】 *aphthous gingivitis 【アミロイド症】【アミロイドーシス】*amyloidosis ＝類澱粉沈着症 【アメーバ症】*amebiasis 【アメーバ性下痢】*amebic diarrhea [medo.jp]

• Erythema

  Physical examination usually reveals tenderness, erythema, and local edema over the joint. Treatment of subacromial bursitis follows the same basic principles as other forms of bursitis. [symptoma.com]

  The skin may also be warm or boggy at this site, although erythema is generally not seen. [ncbi.nlm.nih.gov]

  The prepatellar bursa is also a common site for septic (infectious) bursitis, a diagnosis that should be considered when there is skin injury, erythema, warmth, or severe tenderness over the patella. [emedicine.medscape.com]

  […] multiforme exudativum[L] 【多形滲出性紅斑様薬疹】*erythema multiforme exudativum-like drug eruption 【多形性紅斑】*erythema multiforme[L] 【多形性腺腫】*pleomorphic adenoma 【多形性肉腫】【多形型肉腫】*pleomorphic sarcoma 【多形皮膚萎縮症】*poikiloderma 【多血球症】*polyglobulism 【多血症】*polycythemia ^＝赤血球増加症 [medo.jp]

• Shoulder Pain

  Secondary outcome measures were the Shoulder Pain and Disability Index, the Shoulder Disability Questionnaire, and the 36-item Short-Form Health Survey (SF-36). [ncbi.nlm.nih.gov]

  A more thorough review for diagnosing shoulder pain may be found in the article “Approach to the patient with shoulder pain” ( J Fam Pract 2002; 7:605–611). [jfponline.com]

  Shoulder Pain & Bursitis admin 2019-02-05T08:18:25+00:00 Subacromial Bursitis & Shoulder Pain SYMPTOMS : Pain on the outside of your shoulder, pain may also spread down your arm towards the elbow or wrist. [apexphysio.com.au]

  The most common signs and symptoms include: lateral shoulder pain pain with lying on the affected shoulder pain with overhead activity a painful arc of movement Shoulder bursitis is normally successfully managed with physiotherapy treatment. [ballsbridgephysio.ie]

• Arthritis

  Rice body formation is a nonspecific response to chronic synovial inflammation associated with tuberculous arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, seronegative inflammatory arthritis, and even osteoarthritis. [ncbi.nlm.nih.gov]

  Pseudogout Imaging X-rays help to visualize bone spurs, acromial shape, and arthritis. [boneandspine.com]

  Stress or inflammation from other conditions, such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders, or unusual medication reactions may also increase a person’s risk. [arlingtonortho.com]

• Frozen Shoulder

  Tim Bunker, Time for a new name for frozen shoulder—contracture of the shoulder, Shoulder & Elbow, 1, 1, (4-9), (2009). [doi.org]

  About Frozen Shoulder The cause of frozen shoulder is not always clear, but it can develop as a result of another painful shoulder disorder, such as bursitis. [livehealthy.chron.com]

  As a physiotherapist, we should be able to diagnose bursitis from either rotator cuff injury or shoulder osteoarthritis. However, for patient who suffers subacromial bursitis are likely to have frozen shoulder or shoulder tendinitis. [khpoon.com]

  Loss of motion in the shoulder — called “adhesive capsulitis” or frozen shoulder — can also be a sign of bursitis. [arlingtonortho.com]

  But 30 percent of the patients experience the situation when the disease turns into “frozen shoulder” (adhesive capsulitis of shoulder). Subacromial Bursitis Treatment An operating surgeon or a therapist deal with subacromial bursitis treatment. [yourhealthyjoints.com]

• Muscle Weakness

  Symptoms If you have shoulder bursitis, you may have Pain that worsens with shoulder movement Tenderness at the top or front of your shoulder Muscle weakness Difficulty moving your shoulder, especially reaching overhead Treatments The type of treatment [physicaltherapynotes.com]

  The patient complains of pain in the shoulder on anterior and lateral aspect and may be associated with weakness and stiffness. Weakness without pain may suggest rotator cuff tear or suprascapular nerve compression. [boneandspine.com]

  This pain is often associated with muscle weakness as well as lost range of motion in the shoulder. A Subacromial Bursitis causing Shoulder Impingement will often have lateral shoulder pain as well. [doctorschierling.com]

  Poor posture Inadequate warm up before performing a sporting activity Rotator cuff muscle weakness Inadequate rehabilitation after a previous injury to the shoulder Symptoms Of Subacromial Bursitis Individuals affected with Subacromial Bursitis usually [epainassist.com]

• Osteophyte

  Anomalies to the acromion bone, degenerative changes to the AC joint, or bony spurs known as osteophytes, may predispose a patient to developing subacromial bursitis. [athleticedge.biz]

  Anomalies of the acromion bone, degenerative changes to the AC joint, or bony spurs known as osteophytes, may predispose a patient to developing subacromial bursitis. [physioadvisor.com.au]

  Common causes of anatomical narrowing include subacromial osteophytes or anatomical variants of the acromion. [mja.com.au]

• Suggestibility

  Although further investigation is required, these studies suggest that inflammation of the subacromial bursa does occur in patients with rotator cuff disease. [ncbi.nlm.nih.gov]

  A systematic review suggested that clinical examination by specialists could rule out the presence of a rotator cuff tear, 16 and both clinical and ultrasound studies suggest that inter-examiner reproducibility can be improved with training. 5,19,38,45,46,48 [mja.com.au]

  He also suggested that the portion of the rotator cuff that is impinged upon (the impingement zone) is centered on the insertion of the supraspinatus tendon on the greater tuberosity. [doi.org]

  A white blood cell count of between 5,000 and 20,0000 is still suggestive of septic bursitis. [symptoma.com]

• Radiculopathy

  Subacromial bursitis may be present concomitantly with shoulder arthritis, rotator cuff tendinitis, rotator cuff tears, and cervical radiculopathy may be present. [boneandspine.com]

  The neck is examined as part of any shoulder evaluation because pain can be referred to the shoulder from the cervical spine (particularly with C5 radiculopathy). [msdmanuals.com]

  Individuals affected by subacromial bursitis commonly present with concomitant shoulder problems such as arthritis, rotator cuff tendinitis, rotator cuff tears, and cervical radiculopathy (pinched nerve in neck). [en.wikipedia.org]

• Cervical Radiculopathy

  Subacromial bursitis may be present concomitantly with shoulder arthritis, rotator cuff tendinitis, rotator cuff tears, and cervical radiculopathy may be present. [boneandspine.com]

  Individuals affected by subacromial bursitis commonly present with concomitant shoulder problems such as arthritis, rotator cuff tendinitis, rotator cuff tears, and cervical radiculopathy (pinched nerve in neck). [en.wikipedia.org]

• Radiculitis

  It is important to differentiate subacromial impingement syndrome from other conditions that may cause symptoms in the shoulder, such as glenohumeral instability, cervical radiculitis, calcific tendinitis, adhesive capsulitis, degenerative joint disease [doi.org]

  SUPRASPINATUS TENDINOSIS : ROTATOR CUFF TENDINOSIS : SUBACROMIAL BURSITIS : Bone Spurs ( DEGENERATION ): Shoulder Instability (Previous Dis locations or S eparations) : Loss of Rotator Cuff Strength: RADICULITIS or Nerve Entrapment: (entrapment of the [doctorschierling.com]

• Paresis

  (OA) 骨関節症、変形性関節症 osteogenesis imperfecta (OI)骨形成不全症 osteoid osteoma類骨骨腫 osteon骨単位、オステオン osteoporosis骨粗鬆（しょう）症、オステオポローシス osteosarcoma骨肉腫 p pain 疼痛 palm手掌 palpation 触診［法］ palsy麻痺〈paralysisもみよ〉 paralysis麻痺〈palsyもみよ〉 paraplegia対麻痺 parathyroid gland上皮小体 paresis [tokyo-med.ac.jp]

  RA) 【不可避流産】*inevitable abortion 【不完全ブロック】*partial block 【不整脈】*cardiac arrhythmia/*arrhythmia 【不全感染】【不発感染】*abortive infection (＝頓挫感染) 【不全症】*insufficiency 【不全整復】*malreduction 【不全脱臼】*incomplete dislocation *[＝亜脱臼] subluxation 【不全対麻痺】*paraparesis 【不全麻痺】*paresis [medo.jp]

• Asthenia

  (＝爪甲欠損症) 【無足症】*apodia 【無足体】*apus 【無胆汁症】*acholia 【無胆汁尿症】*acholuria 【無痛覚】*analgia 【無動症】*akinesia (＝失動症、運動不能) 【無排卵症】*anovulation 【無排卵性月経】*anovulatory menstruation *anovular menstruation 【無発生】【無発育】*agenesis 【無乳症】*agalactia 【無尿症】*anuria (＝尿閉) 【無力症】【無気力】*asthenia [medo.jp]

Laboratory blood studies are usually not necessary in subacromial bursitis, except in cases of septic bursitis in which white blood cell count and erythrocyte sedimentation rate are necessary and are typically elevated. In septic subacromial bursitis, blood cultures may also be necessary. Furthermore rhematoid factor (RF), antinuclear antibody (ANA) and anti-citric citrllinated peptide (anti-CCP) tests may also be done to exclude underlying inflammatory or autoimmune diseases.

Bursal fluid aspiration for analysis is necessary for suspected infectious or rheumatic bursitis. This may also be a therapeutic procedure to reduce the fluid content of the bursa. In nonseptic bursitis, white blood cell count in the bursal fluid is often lower than 2000/µL with mononuclear cells being predominant. However, in septic bursitis white blood cell counts exceed 70,0000/µL with the polymorpomonuclear( PMN) cells being predominant. A white blood cell count of between 5,000 and 20,0000 is still suggestive of septic bursitis. Gram stain and culture of the joint fluid are also considered to evaluate an infective bursitis, however, a negative gram stain doesn't exclude septic bursitis. Bursal fluid culture is the diagnostic test of choice to confirm septic bursitis. Chronic and recurrent subacromial bursitis require the exclusion of tuberculosis, hence bursal fluid for acid fast bacilli (AFB) is recommended.

Imaging studies are usually not necessary in making a diagnosis of subacromial and other forms of bursitis, but they may be necessary to exclude underlying gross bone pathology such as fractures. Plain radiographs may reveal joint effusions and calcification of the bursal walls and tendons in chronic bursitis. Magnetic resonace imaging (MRI), although not routinely indicated, may reveal bursal abscesses [6]. It is highly sensitive for the diagnosis of bursitis and necessary for excluding suspected bone malignancies.

Bone ultrasonography is usually not sensitive for bursitsis, but it is indicated for guidance in bursal fluid aspiration or therapeutic injections. Studies to prove its efficacy over injections or aspirations without ultrasound guidance have yielded controversial results [7]. Ultrasonography is necessary in distinguishing cystic from solid masses and in the diagnosis of popliteal bursitis (Baker cysts) when it coexists with other joint disorders [8].

Treatment approach is similar for all types of bursitis irrespective of the location. Treatment of bursitis basically begins with lifestyle modification and conservative medical care. In the case of subacromial bursitis, lifestyle modifications include avoidance of inciting or aggravating activities such as swimming, heavy lifting, and sporting activities which requires frequent lifting of the arms over the head.

Rest of the affected shoulder is very essential in the management of subacromial bursitis. However, stretch exercises are also beneficial to prevent weakening of the muscles and ligaments of the shoulder joint which may aggravate the pain and inflammation. Application of ice packs on the affected area is also important especially within the first 24 hours of onset of symptoms. Ice packs are effective if applied several times daily for at least 10 minutes each time. To prevent skin irritation, ice should not be applied directly to the skin.

Mild analgesics including NSAIDs and acetaminophen are necessary for pain relief. Topical NSAIDs may be preferrable. Antibiotics are administered if infective bursitis is confirmed.

Corticosteroid injections are the second line of treatment if the conservative management fails [9]. Corticosteroid are indicated in all sites of bursitis except retrocalcaneal bursa because of the possibility of tendon rupture. They are also not indicated in infective bursitis.

Surgery is the final treatment option indicated if every other option fails to resolve the symptoms of bursitis, and consists in a procedure called bursectomy [10] [11]. Surgical treatment of subacromial bursitis involves a subacromial decompression.

A study by Morrison et al reveals that the prognosis of the bursitis depends on age, such that patients who are aged 20 or younger and those aged between 41 and 60 fared better than those aged between 21 and 40. This may be attributed to the increased work stress, tendency for sports engagement, and overuse of shoulder muscles in this age group. Patients older than 60 years often have the poorest outcome due to the coexisting degenerative changes in the rotator cuff structures with ageing, however, the authors attributed the poor outcome in these individuals to undetected full-thickness tears of the tendons of the rotator cuff muscles [5].

Subacromial bursitis results from tendinitis of the rotator cuff muscles particularly the supraspinatus being directly under the bursa. Injury to the rotator cuff muscles may be acute such as a strain or trauma, or chronic from overuse. Chronic injury to the rotator cuff muscles may be as a result of supraspinatus tendonitis sequel to prolonged impingement of the tendon between the coraco-acromial arch and the humeral head. Activities which predispose to such tendonitis generally are those which require the arms to be moved over the head repeatedly. These include serving ball in racket sports, swimming backstroke or butterfly patterns, and pitching in baseball. Such repeated arm movements are also common among painters and wallpaper hangers making these jobs important risk factors for developing subacromial tendinitis.

Another factor which makes the supraspinatus tendon susceptible to injury is the poor vascularity at its insertion to the greater tubercle of the humerus. The consequent inflammation further narrows the subacromial space exercebating the tendon injury and causing subacromial bursitis. Furthermore, if the inflammation is not controlled, it could result in a complete or partial tear of the tendon.

Rotator cuff tendinitis is not always sport-related, degenerative tendinitis may occur in non-athletes over the age of 40.

Bursitis constitutes 0.4% of cases in general practice. Commonly encounted bursitis include subdeltoid, trochanteric, prepatellar, olecranon, and ischial bursitis.

Bursitis are commonly encountered in athletes with an incidence rate of up to 10% in runners. As noted in a French study done to determine the incidence of knee bursitsis among male workers, knee bursitis occurred more in the male workers whose jobs required frequent kneeling [2].

Bursitis is not associated with significant mortality. Outcome is excellent with adequate treatment and follow up.

Inflammation of the bursa results in proliferation of the synovial cells with a resultant increase in collagen production and deposition. This synovial cell multiplication is associated with exudation of protein-rich fluid and subsequent local edema. The fluid may become hemorrhagic [3]. This process is suggested to be mediated by cytokines, cyclooxygenases, and metalloproteinases. The associated fibrosis from collagen synthesis causes replacement of the bursal lining by granulation tissue.

There are three phases of bursitis: acute, chronic, and recurrent [4]. The acute phase presents with local inflammation and painful movement around the joint related to the bursa. Chronic bursitis results from poor or lack of treatment of an acute bursitsis. This results in worsened pain and weakening of the overlying ligaments and tendons from disuse atrophy.

The subacromial bursa becomes inflamed secondary to injury of the supraspinatus tendon, therefore, both conditions are often coexistent. The tendinitis may further progress to causing partial or complete-thickness tears of the tendon.

Prevention of subacromial bursitis basically involves avoidance of shoulder overuse and limiting activities which put stress on the shoulder like sporting activities such as swimming, baseball and racket sports. In individuals in whom restricting these activities may be difficult, such as in athletes and in persons with at-risk jobs, protective pads on the shoulders are recommended.

Subacromial bursitis refers to an inflammation of the subacromial bursa which is located between the undelying supraspinatus tendon and the overlying acromial arch (consisting of the coraco-acromial ligament, the acromion, the coracoid and the deltoid muscle. The bursae are fluid-containing sac-like structures found between skin and bones, or between bones and tendons. Bursae are lined by synovial tissues which produce fluid which serves as a lubricant reducing friction between these tough structures as they glide over each other during the movement of the joint.

Subacromial bursitis, like all other forms of bursitis, occurs as a result of inflammatory changes in the synovial lining, which makes it thickened, producing excess fluids which in turn causes local edema and pain. Subacromial bursitis is caused by a primary inflammation of the supraspinatus tendon which results from acute injury, overuse, degenerative changes, or underlying chronic inflammatory diseases such as gout. These are implicated in the etiopathogenesis of all forms of bursitis. Furthermore, bursitis may result from infective causes, however, these are rarely implicaed in subacromial bursitis.

Symptoms of subacromial bursitis include shoulder pain which is worsened by movement of the shoulder and the difficulty in moving the arm around the shoulder joint. Physical examination usually reveals tenderness, erythema, and local edema over the joint.

Treatment of subacromial bursitis follows the same basic principles as other forms of bursitis. This include an initial conservative approach involving restriction of aggravating activities, cold compression, rest, and analgesia. If these methods fail to resolve the symptoms, intralesional cortcosteroids are recommended. Surgical removal of the bursa is recommended in unresponsive or chronic cases.

Oveview.

Bursitis is an inflammation of the bursa (plural form is bursae). Bursae are fluid-containing sac-like structures which occur naturally between bones and skin, bones and tendons, or bones and ligaments.

Subacromial bursa is the inflammation of the subacromial bursa. The subacromial bursa is located between the tendon of a muscle called supraspinatus muscle and the ligaments and bones of the shoulder joint.

Etiology.

Subacromial bursitis is caused by inflammation of the supraspinatus tendon( tendinitis). This tendinitis can be caused by direct injury, falls or blows to the shoulder resulting in injury to the rotator cuff muscles. The rotator cuff muscles consists of four muscles (teres minor, subscapularis, infraspinatus, and supraspinatus) which are responsible for moving the shoulder up, down, and sideways). Repeated movements of the arm over the head as in sports such as baseball, swimming, and racket sports are common causes of rotator cuff muscle tendinitis. Jobs which place an individual at risk of subacromial bursitis include painting and wallpaper hanging.

Ageing has been implicated in the cause of subacromial bursitis in those older than 40 years. Subacromial bursitis, like all other forms of bursitis, may also result from underlying inflammatory diseases of the joints such as gout and lupus.

Presentation.

Subacromial bursitis usually presents with shoulder pain which is worse when moving the shoulder over the head, mild swelling of the shoulder, weakness of the muscles of the affected shoulder, redness and warmth of the skin over the shoulder. If infection is the cause of the bursitis, fever may be present.

Workup.

Diagnosis of subacromial bursitis can be made initially from the history and physical examinations. The history consists of questions which the doctor would ask the patient to determine what must have caused the presenting symptoms.

Blood workup is not necessary to confirm subacromial bursitis but may be recommended to exclude other causes of similar symptoms. However, blood cultues would be ordered if an infective cause is suspected.

X-rays, Magnetic resonance imaging (MRI), Ultrasound and Contrast Tomography (CT) scans are not routinely indicated for confirmation of the diagnosis but may help in ruling out other bone diseases such as bone cancers.

The diagnostic investigation necessary in bursitis is aspiration and analysis of the fluid in the bursa. This fluid may be analysed for white blood cell count, bacterial infection, and other inflammatory diseases.

Treatment.

The treatment of subacromial bursitis follows the same principle as for other forms of bursitis. It consists of an initial conservative treatment which includes resting the affected joint, application of ice packs over the area everyday for 10 minutes each time, avoiding activities which worsen or trigger the pain, stretch exercises as recommended by a physiotherapist, and use of over-the-counter pain killers.

This conservative treatment is often successful. However, it is fails, your doctor may recommend injecting steroids into the bursa. If all else fails, surgical removal of the bursa, called bursectomy, is the final option.

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