Subacromial bursitis

Overview
Subacromial bursitis is inflammation of the subacromial bursa, which lies between the acromion and the head of the humerus leading to extreme pain.

Differential diagnosis of causes of subacromial bursitis
The cause of the condition is often unclear. It can in some cases be blamed either on repeated minor traumata or on a single more significant injury, but in a large percentage of sufferers there is no obvious or remembered cause. Other conditions that will cause pain and limitation of movement at the shoulder joint, include adhesive capsulitis and supraspinatus tendinitis.

Signs and symptoms
The presenting symptom is of pain in the shoulder on abduction of the arm, either actively or passively. Typically, movement at the shoulder either backwards or forwards in the sagittal plane causes little or no pain; rotation in either direction, however, is usually painful. The pain can be felt locally in and around the deltoid muscle or it may seem as if it is spreading down the arm towards the elbow. ,

Treatment
The definitive, and curative, treatment is by injection of a hydrocortisone-type medication, ideally one which will remain active for a significantly long period of time, (a so-called depot injection) into the bursa. Orally administered or topically applied non-steroidal anti-inflammatory medications (NSAIDs) will provide some degree of symptom relief, but will not provide a cure. As a number of other conditions will cause pain and limitation of movement at the shoulder joint, such as adhesive capsulitis and supraspinatus tendinitis, it is important to make an exact diagnosis, as a steroid injection into the wrong place will be wholly ineffective.