Shoulder 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.
- 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.