Shoulder Bursitis, Tendonitis & Impingement

Diagnosis/Definition

• 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.

Initial Diagnosis and management

• History and Physical exam.
• Plain radiographs are not required unless subacromial DJD is suspected.
• NSAIDs.
  • Adults - 200 to 400 milligrams (mg) every four to six hours as needed for up to 2 weeks. Example: Ibuprofen
  • Take tablet or capsule forms of these medicines with a full glass (8 ounces) of water.
  • Do not lie down for about 15 to 30 minutes after taking the medicine. This helps to prevent irritation that may lead to trouble in swallowing.
  • To lessen stomach upset, these medicines should be taken with food or an antacid.
• Appropriate activity limitations (i.e. no overhead activities)
• Encourage active ROM for the shoulder in all planes.
• Use of ice packs for 20 minutes every 2 hours for 72 hours.
• Total immobilization is contraindicated.

Ongoing Management and Objective

• Expect resumption of active ROM with minimal pain after 7-14 days is expected.
• 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

Indication a profile is needed

• Any limitations that affect strength, range of motion, and general efficiency of upper arm, shoulder girdle, and upper back, including cervical and thoracic vertebrae.
• Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent hand-to-hand fighting and disqualifies for prolonged effort.
• Defects or impairments that require significant restriction of use