Subacromial impingement & bursitis
What is Subacromial impingement & bursitis?
Subacromial impingement and bursitis describe pain arising from inflammation of the bursa and irritation of the rotator cuff tendons beneath the acromion. It is often related to cuff overload, shoulder stiffness, scapular mechanics or tendon degeneration rather than simply a lack of space.
Common symptoms
Typical symptoms include pain with reaching overhead, a painful arc when lifting the arm, night pain when lying on the shoulder, weakness due to pain, and difficulty with tasks such as dressing, swimming, serving or gym pressing.
Diagnosis and imaging
Diagnosis is based on examination of shoulder motion, cuff strength, impingement signs and scapular control. X-rays assess bone shape, arthritis and calcific deposits. Ultrasound or MRI can identify bursitis, tendinopathy, calcific tendonitis or a rotator cuff tear when symptoms persist or strength is reduced.
Non-surgical treatment
Most patients improve with physiotherapy that restores movement, improves rotator cuff capacity and optimises shoulder blade mechanics. Activity modification, anti-inflammatory measures and carefully targeted corticosteroid injection can help reduce pain enough to rehabilitate effectively.
Surgical treatment
Surgery is reserved for persistent symptoms that fail a structured non-surgical program or when there is associated pathology requiring treatment. Arthroscopy may include bursectomy, assessment of the cuff and selective decompression or repair where indicated.
Recovery and follow-up
Recovery is usually rehabilitation-led. After non-surgical treatment, improvement is often gradual over weeks to months. After arthroscopy, early motion is encouraged, with strengthening and return to sport or work progressed according to pain, strength and any tendon repair performed.
Subacromial impingement & bursitis FAQs
Is impingement just a bone spur rubbing on the tendon?
Not always. Modern treatment focuses on the whole shoulder, including tendon health, strength, stiffness and movement patterns. Bone shape may contribute, but it is rarely the only factor.
How is subacromial impingement & bursitis diagnosed?
Diagnosis starts with a focused history and examination, then uses imaging selectively to confirm the pattern of injury, exclude related problems and plan treatment accurately.
Will an injection fix bursitis permanently?
An injection can reduce inflammation and pain, but it works best when paired with rehabilitation. Without addressing strength, load and movement factors, symptoms can return.
Will I need surgery for subacromial impingement & bursitis?
Many patients improve without surgery. Surgery is considered when symptoms remain limiting despite appropriate non-surgical care, when there is significant structural damage, or when delay may compromise function.
When can I return to swimming, tennis or gym training?
Return depends on the diagnosis, treatment type, tissue healing and the physical demands of the activity. The plan is usually staged, with strength, range of motion and confidence rebuilt before unrestricted loading.
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