Subdeltoid bursitis

Anatomy: Where is the subdeltoid bursa?

Bursae are fluid-filled gliding cushions that reduce friction between tendons, muscles and bones. Several bursae lie close together on the shoulder.

• Subdeltoid Bursa: lies beneath the deltoid and above the rotator cuff; it makes it easier for the deltoid muscle to glide over the tendons.
• Subacromial bursa: lies under the bony shoulder roof (acromion). There is often a connection between the subacromial and subdeltoid bursa; Inflammation therefore often affects both (subacromial-subdeltoid bursitis).
• Neighborhood: Rotator cuff (supraspinatus, infraspinatus, subscapularis, teres minor), biceps tendon (LBS), acromioclavicular joint.

If there is overload, tightness under the acromion or friction from tendon irritation, the bursa can swell and become painfully inflamed.

Symptoms: How do you recognize subdeltoid bursitis?

• Lateral, stabbing shoulder pain, often radiating to the upper arm.
• Pain when spreading and lifting the arm (pain arc between approx. 60-120°).
• Tenderness over the outer shoulder area, increased under the deltoid muscle.
• Night pain, especially when lying on the affected side.
• Restriction of movement due to pain; Strength often seemingly reduced.
• Occasionally warm or slightly swollen; However, visible swelling on the shoulder is rare.

Warning signs of a possible infection (septic bursitis) include fever, severe redness/warmth, severe pain at rest and a general feeling of illness. In these cases, medical attention should be sought immediately.

Causes and risk factors

• Overhead loads and repetitive arm lifting movements (e.g. crafts, painting, tennis, volleyball, swimming).
• Impingement syndrome due to tightness under the acromion or bony attachments.
• Accompanying tendon irritation of the rotator cuff (tendinopathies) or calcium deposits (tendinosis calcarea).
• Acute overload or microtrauma, rarely direct fall.
• Systemic factors: diabetes, thyroid diseases, rheumatic diseases.
• Postural and muscle imbalances (scapular dyskinesia, weak external rotators/scapular stabilizers).
• Smoking and short recovery times can slow healing processes.

Diagnostics: This is how we proceed

Diagnosis is based on a careful history, physical examination and, if necessary, imaging tests. The goal is to differentiate bursitic pain from tendon problems and other causes of shoulder pain.

• Medical history: course of pain, triggers, stress, night pain, previous illnesses.
• Clinical tests: painful arch, Hawkins-Kennedy and Neer test (impingement sign), tenderness under the deltoid muscle.
• Sonography (ultrasound): shows thickened bursa with increased fluid; can be assessed dynamically, suitable for injection guidance.
• X-ray: assessment of bone structures and calcium deposits.
• MRI: if the findings are unclear, resistance to therapy, suspected rotator cuff tear or if surgery is being considered.
• Laboratory/puncture: if infection (CRP/leukocytes) is suspected, a targeted puncture for germ diagnosis may be necessary.

Differential diagnoses: rotator cuff tendinopathy, biceps tendonitis, calcific shoulder, AC joint arthrosis, frozen shoulder, cervical root irritation.

Conservative therapy: gradual and targeted

The focus is on pain-adapted, gradual treatment. Most patients benefit from a combination of stress control, physiotherapy and short-term pain therapy.

Training principles: Start with low-pain isometric exercises, progress to light resistance and functional movements. Slowly increase the stimulation dose and use pain the following day as feedback.

Targeted interventions: injections and other options

If the symptoms persist with consistent conservative therapy, targeted measures can be considered. Benefits, risks and alternatives are weighed individually.

• Ultrasound-targeted injection into the bursa: A low-dose corticosteroid with local anesthetic can attenuate the inflammation in the short term. This often leads to pain reduction over weeks and makes physiotherapy easier. Limit frequency (e.g. maximum 2-3/year) to minimize side effects.
• Risks of injections: temporary increase in pain, skin atrophy/depigmentation, infection (very rare), tendon irritation if placed incorrectly.
• Puncture/aspiration: if septic bursitis is suspected for diagnosis and relief.
• Shock wave (ESWT): not primary therapy for isolated bursitis; can be considered if there is an accompanying calcification shoulder.
• Biological methods (e.g. PRP): evidence is limited for pure bursitis; Use only after informed consent and individual indication, no standard therapy.

Surgical therapy: Rarely required

Operations are usually not necessary. An arthroscopic bursectomy and, if necessary, subacromial decompression are only considered in cases of persistent, treatment-resistant symptoms (>3–6 months) and proven structural tightness or relevant accompanying lesions.

• Indications: recurrent bursitis with impingement, bony narrowing, accompanying rotator cuff pathology.
• Goals: Reduce pain by removing inflamed bursa layers and eliminating mechanical tightness.
• Risks: infection, stiffness, persistent pain; Benefits vary from person to person.
• Rehabilitation: early functional, gradual increase in load in collaboration with physiotherapy.

Course and prognosis

With consistent conservative treatment, symptoms often improve significantly within 6-12 weeks. If there is severe inflammation or persistent triggers (e.g. constant overhead work), healing may take longer. Relapses are possible, but can often be prevented through targeted training and stress control.

Prevention: Protect the shoulder joint in the long term

• Regular strengthening of the external rotators and scapula stabilizers.
• Warming up before sports and physical work; Technical training for overhead sports.
• Set up your workplace ergonomically and carry loads close to your body.
• Increase the load gradually and plan sufficient recovery periods.
• Address risk factors such as smoking and poorly controlled diabetes.

Self-help: What you can do yourself

• Cold in the acute phase, later warm before training.
• Painless pendulum exercises, gentle mobilization in the frontal and scapular planes.
• Isometric external rotation/abduction with small resistance, 3×/week.
• Sleep: do not lie on the affected shoulder; Use pillows for arm support.
• In everyday life, distribute repeated overhead work over several short units.

When should you seek medical advice?

• Severe pain, significant restriction of movement or pain at night when resting for several days.
• Fever, redness/warmth of the shoulder, general feeling of illness.
• After a fall/trauma with immediate reduction in pain and strength.
• Complaints >2–3 weeks despite rest and self-exercises.
• Recurring episodes or unclear pain radiating to the arm.

Special features of sport and work

Overhead athletes and people with repetitive overhead activities are particularly at risk. Early adjustment of the load and technique is crucial.

• Return to sport: pain-free full range of motion, sufficient strength of the external rotators and scapular stabilizers, negative stress tests.
• Return to work: gradual increase; If necessary, temporary workplace adjustments (aids, break plans).
• Integrate preventive strength and coordination training into your week.

Related to the rotator cuff

Subdeltoid bursitis often occurs along with rotator cuff irritation. Therefore, treating the underlying tendon problem is an important component. Depending on the findings, specific programs for supraspinatus, infraspinatus, subscapularis or teres minor may be useful.

Frequently asked questions (FAQ)