Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Investigations: Diagnosis of shoulder bursitis is primarily clinical based on history and physical examination; routine imaging is not typically required initially unless red flags are present or if symptoms do not improve with conservative management. Consider referral for ultrasound or MRI if diagnosis is uncertain or if symptoms persist beyond 3 months despite appropriate treatment.
Management Strategies:
- Rest and Activity Modification: Advise rest during the acute phase and gradual resumption of activities within pain limits. Modify or avoid activities that exacerbate pain, particularly overhead movements causing pain in the painful arc between 60 and 120 degrees NICE CKS.
- Analgesia: Initiate pain relief with paracetamol as first line. If ineffective, consider a short course (maximum 2 weeks) of oral NSAIDs, accounting for contraindications and risks. Codeine may be considered if NSAIDs and paracetamol are insufficient. Topical NSAIDs and opioids have insufficient evidence for benefit NICE CKS.
- Physiotherapy and Exercise: Refer for physiotherapy focusing on postural correction, motor control retraining, stretching, and strengthening of rotator cuff and scapular muscles, with low intensity/high-frequency exercise within pain tolerance. Physiotherapy usually lasts about 6 weeks, extendable based on progress NICE CKS.
- Corticosteroid Injections: Consider subacromial corticosteroid injection in people with severe pain or limited progress after conservative treatments within the first 8 weeks as part of shared decision making. Use triamcinolone or methylprednisolone with local anaesthetic (e.g., lidocaine), administered by trained personnel with informed consent, explaining risks such as infection, tendon rupture, post-injection flare, and hyperglycaemia in diabetics. Advise rest of the joint for 24 hours post-injection NICE CKS.
- Referral: Refer to secondary care if severe pain persists beyond 3 months despite conservative management or if red flags such as significant functional impairment or trauma are present NICE CKS.