Subacromial Bursitis and Impingement

Abstract

Subacromial bursitis is caused by compression and inflammation of the subacromial bursa, which is situated above the rotator cuff muscles just below the acromion (Fig. 10.1). Shoulder impingement syndrome is a condition in which the rotator cuff tendons are trapped and compressed in the subacromial space. Patients often present with shoulder pain and tenderness over the subacromial/subdeltoid region. In shoulder impingement, they commonly report shoulder pain with overhead activities. On exam, it is important to test for impingement signs including Neer’s, Hawkins, painful arc, and supraspinatus test. In the acute phase, conservative treatment includes relative rest with avoidance of activities that exacerbate the symptoms, NSAIDS, and physical therapy. If conservative treatment fails, injections such as corticosteroid- or platelet-rich plasma can be considered. A referral to orthopedic surgery may be necessary if imaging reveals a rotator cuff tear or if the patient continues to report pain and limited movement despite conservative management.