Shoulder bursitis involves the inflammation of bursae, which are small, fluid-filled sacs that cushion bones, tendons, and muscles around the shoulder joint. These sacs function to reduce friction and facilitate smooth movement within the joint. When a bursa becomes inflamed, it can lead to pain, swelling, and restricted shoulder motion. An accurate diagnosis is important for effective treatment and to distinguish bursitis from other conditions causing shoulder discomfort.
Initial Medical Evaluation
The diagnostic process begins with a thorough medical evaluation. This starts with gathering a detailed patient history, where individuals describe their symptoms. Questions cover the onset of pain, its characteristics—whether it is sharp, dull, constant, or intermittent—and activities that either worsen or alleviate the discomfort. Information about previous shoulder injuries, any impact on sleep patterns, and overall health status is also collected.
A physical examination assesses the shoulder directly. The healthcare provider will observe the shoulder for any visible swelling, redness, or tenderness. They will also evaluate the shoulder’s active and passive range of motion, noting any limitations or pain during movement. Specific orthopedic tests, such as the Neer’s or Hawkins-Kennedy tests, might be conducted to identify areas of impingement or pain.
Diagnostic Imaging and Specialized Tests
Diagnostic imaging and specialized tests often follow to confirm a diagnosis or rule out other conditions. X-rays are typically among the first imaging tests ordered, primarily to visualize bones. While X-rays cannot directly show bursitis, they are useful for identifying bony abnormalities such as fractures, arthritis, or bone spurs that might contribute to shoulder pain.
Ultrasound is a common and effective tool for visualizing soft tissues around the shoulder. This imaging technique can show an inflamed bursa, revealing thickening of its membrane or the presence of excess fluid within the sac. Ultrasound can also assess the surrounding tendons for inflammation or damage.
Magnetic Resonance Imaging (MRI) offers more detailed images of both bone and soft tissues. An MRI is often used when ultrasound results are inconclusive or when other soft tissue injuries, such as rotator cuff tears, are suspected. It provides comprehensive views of inflammation, fluid accumulation, and tendon damage.
Aspiration may be performed, where fluid is carefully drawn from the bursa using a needle. This fluid is then sent for laboratory analysis to check for signs of infection, such as bacterial growth, or the presence of crystals that indicate conditions like gout. Aspiration helps determine if the bursitis is septic (infected) or crystal-induced, which require specific treatments. Additionally, blood tests might be conducted to check for markers of systemic inflammation or infection, particularly if septic bursitis is a concern. These tests can measure inflammatory markers like erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), and may include a complete blood count.
Distinguishing Shoulder Bursitis from Other Conditions
Distinguishing shoulder bursitis from other conditions that cause similar pain is important for diagnosis. Pain from bursitis can often mimic that of rotator cuff tendinopathy or tears, which involve inflammation or damage to the tendons that stabilize the shoulder. Specific physical tests during the examination, along with imaging like MRI, help differentiate these conditions, as bursitis frequently coexists with rotator cuff issues.
Shoulder impingement syndrome, where tendons or the bursa are compressed during arm movement, also presents with similar symptoms. Bursitis is often a component of impingement, and the diagnostic steps clarify whether the bursa is the primary source of pain or part of a broader impingement issue.
Conditions such as frozen shoulder can also cause shoulder pain and stiffness. However, frozen shoulder typically involves a progressive loss of both active and passive range of motion, which is usually more pronounced and distinct from the limitations seen with bursitis. Arthritis is another consideration, and imaging studies like X-rays are crucial for ruling out joint surface damage as the main cause of pain. Occasionally, pain originating from nerve entrapment or referred pain from the neck can be mistaken for shoulder bursitis. A thorough neurological examination and careful analysis of the pain’s pattern and radiation help differentiate these nerve-related issues from bursal inflammation.
Preparing for Your Diagnostic Appointment
Preparing for a diagnostic appointment aids accurate assessment. It is helpful to track your symptoms by noting when they began, what activities worsen or improve the pain, and how intense the pain is on a consistent basis.
Compiling a comprehensive medical history is also beneficial. This should include a list of any past injuries, all current medications, and any known allergies. Having previous imaging reports or test results available saves time and provides context.
Consider preparing a list of questions to ask your doctor about the diagnostic process, potential causes of your pain, and proposed next steps. Communicating openly and honestly about your symptoms and concerns is important for developing an effective treatment plan. Wearing comfortable clothing that allows easy access to your shoulder for examination can also make the visit more efficient.