Aubacromial Bursitis versus Rotator Cuff Syndrome! - USMLE Forums
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Old 07-22-2012
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Rheumatology/Orthopedics Aubacromial Bursitis versus Rotator Cuff Syndrome!

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Old 07-22-2012
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One cause MORE pain with active motion other more with passive. M nt sure but bursitis causes more pain with active motion.
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Old 07-22-2012
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It is often difficult to distinguish between pain caused by bursitis or that caused by a rotator cuff injury as both exhibit similar pain patterns in the front or side of the shoulder (Hartley, 1990).

Subacromial bursitis can be painful with resisted abduction due to the pinching of the bursa as the deltoid contracts (Buschbacher & Braddom, 1994). If the therapist performs a treatment direction test and gently applies joint traction or a caudal glide during abduction (MWM), the painful arc may reduce if the problem is bursitis or adhesive capsulitis (as this potentially increases the subacromial space).

The following clinical tests, if positive, may indicate bursitis:

The patient actively abducts the arm and a painful arc occurs between 80 and 120. This is due to the compression of the supraspinatus tendon or subacromial bursa between the anterior acromial arch and humeral head. When lowering from full abduction there is often a painful “catch” at midrange. If the patient can achieve adequate muscle relaxation, passive motion tends to be less painful (Starr & Harbhajan, 2001).
The patient performs an isometric flexion contraction against resistance of the therapist (Speed’s Test). When the therapist’s resistance is removed, a sudden jerking motion results and latent pain indicates a positive test for bursitis (Buschbacher & Braddom, 1994).
Neer’s Sign: If pain occurs during forward elevation of the internally rotated arm above 90. This will identify impingement of the rotator cuff but is also sensitive for subacromial bursitis (Starr & Harbhajan, 2001).
It is interesting to note that an irritation or entrapment of the lower subscapular nerve, which innervates the subscapularis and teres major muscles, will produce muscle guarding at the shoulder that will restrict motion into external rotation, abduction, or flexion. The aforementioned tests will assist in diagnosing bursitis over other conditions (Hartley, 1990).
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Old 07-23-2012
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When you have Bursitis there is impingement of the structures in the shoulder joint especially the tendons. So Bursitis and Tendonitis usually present together and they are very hard to distinguish clinically.

It is also very hard to distinguish a tear from bursitis/tendonitis. But there is one clinical difference. A tear will present with pain AND weakness.

If Bursitis is the answer then tendonitis will probably not be an answer choice and vice versa.

The way to differentiate a tear from tendonitis/bursitis (this is a very common question), 2 ways you can do this. First, like I mentioned a tear will present with weakness along with pain. Second, by giving a Lidocaine injection. tendonitis/bursitis gets better but a tear will not.
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