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Shoulder Bursitis, Tendonitis & Impingement

Shoulder BursitisShoulder pain arising either with or without trauma in which the active elevation of the shoulder greater than 70-90 degrees is problematic but passive range of motion (ROM) is essentially normal is shoulder bursitis.

Shoulder Bursitis : Initial Diagnosis and Management

  • History and Physical exam for shoulder bursitis.
  • Plain radiographs are not required unless subacromial DJD is suspected.
  • NSAIDs.
  • Appropriate activity limitations (i.e. no overhead activities/profile)
  • Encourage active ROM for the shoulder bursitis in all planes.
  • Use of ice packs for 20 minutes every 2 hours for 72 hours.  Change to heat if necessary after 72 hours.
  • Total immobilization is contraindicated.

Shoulder Bursitis : Ongoing Management and Objectives

  • Expect resumption of active ROM with minimal pain after 7-14 days.
  • If pain and/or limitation of motion does not resolve then:
  • Obtain plain radiographs.
  • Trial of different NSAID.
  • Do not allow “frozen shoulder” to develop.

Shoulder Bursitis : Indications for Specialty Care Referral

  • If 50% or greater limitation of motion on initial or subsequent evaluations.
  • If there is evidence of “frozen shoulder”, i.e., loss of passive ROM for shoulder bursitis.
  • If no improvement after 2 weeks of initial primary care management.
  • Refer to Orthopedic Surgery if after completion of an appropriate physical therapy treatment regime (3 months) there is no improvement in the condition.

Shoulder Bursitis : Criteria for Return to Primary Care

  • Resolution of the acute or chronic symptoms for shoulder bursitis.
  • Patient returns to their own baseline status.