Most often radiographs are normal in the early stages of impingement associated with bursitis. Emergency Department Treatment
The goals of treatment of subacromial bursitis and early rotator cuff tendinitis are twofold: to reduce pain and inflammation and, more importantly, to prevent progression of this reversible process to the irreversible stages of rotator cuff tendinitis and degeneration.
More than 90 percent of patients with subacromial bursitis respond to conservative measures. An effective conservative treatment plan has been outlined previously in this section. Since inflammation of the bursa is typically due to overuse, a short period of relative rest is indicated. Immobilization is not indicated and, in fact, can be detrimental, leading to adhesions and loss of motion. Total inactivity usually is not necessary. Relative rest implies avoidance of those activities that reproduce symptoms; e.g., a tennis player should avoid serving but can continue to hit ground strokes, and a laborer should avoid working with his or her arms over the head. Nonsteroidal anti-inflammatory agents are effective in reducing pain and inflammation. Analgesics are rarely needed to control pain. Localized ice treatment for 10 to 15 min two to three times per day will help reduce pain and inflammation. As pain diminishes, the patient should begin gentle range of motion, stretching, and strengthening exercises.
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