New York State Medical Treatment Guidelines for Bursitis of the Shoulder in workers compensation patients

The guidelines developed by the New York State Workers Compensation Board are intended to assist healthcare professionals in delivering appropriate treatment for bursitis of the shoulder.

Tailored for medical practitioners, these Workers Compensation Board guidelines offer support in determining the right course of action for individuals with shoulder bursitis.

It’s important to emphasize that these guidelines do not replace clinical judgment or professional experience. The final decision on treatment for shoulder bursitis should be a collaborative one, involving the patient and their healthcare provider in consultation.

Inflammation of the Shoulder Bursa Overview

Inflammation, whether acute or chronic, of the bursa—a fluid-filled sac—can arise from factors like trauma, chronic overuse, inflammatory arthritis, or acute or chronic infection. This condition typically manifests with localized pain and tenderness in the shoulder.


History and Mechanism of Injury

  • Mechanism of Injury: Symptoms onset, date, mechanism of onset, and occupational history should be correlated with the intensity, character, duration, and frequency of associated pain and discomfort.
  • History may include nocturnal pain, pain with over-the-shoulder activities, feelings of shoulder weakness, prior treatment for presenting complaints, specific limitations of movement, and pertinent familial history.


Physical Examination Findings

  • Palpation may elicit localized tenderness over the affected bursa or inflamed tendon.
  • Loss of motion during activity.
  • Painful arc may be observed between 40-120 degrees.
  • Bursitis may be associated with other shoulder injury diagnoses like impingement, rotator cuff instability, tendinitis, etc.


Laboratory Tests

Recommended selectively in clinically indicated patients. Indications include ruling out systemic illness or disease when the clinical presentation indicates the necessity for such testing. On rare occasions, testing could include sedimentation rate, rheumatoid profile, complete blood count (CBC) with differential, and serum uric acid level. Routine screening of other medical disorders may be necessary, along with bursal aspiration with fluid analysis.


Testing Procedures: X-Ray

Recommended selectively in clinically indicated patients. Indications include performing plain x-rays to rule out other shoulder pathology.


Non-Operative Treatment Approaches

  • Benefits may be achieved through non-operative treatment procedures, including immobilization, therapeutic exercise, alteration of occupation and workstation, thermal therapy, and ultrasound.
  • Exclusive use of passive modalities should be limited to the first two to three weeks during the acute phase of shoulder discomfort and accompanied by active therapies as soon as appropriate.
  • Return to work without overhead activities and lifting with the involved arm may be permitted once cleared by the physician, gradually progressing to heavier activities.
  • Additional modalities/treatment procedures may include physical medicine and rehabilitation, instruction in therapeutic exercise, proper work technique, manual therapy, vocational rehabilitation, vocational assessment, and an interdisciplinary team approach.

Medication Options
Consideration may be given to medications such as nonsteroidal anti-inflammatories, oral steroids, and analgesics.


Intrabursal Injection with Steroids

  • Recommended
    • Frequency: Not exceeding two to three times annually. Usually, one or two injections are sufficient.
    • A minimum interval of three weeks between injections is recommended.
    • Maximum duration: Limited to three injections annually at the same site.


Operative Procedures

  • Not Recommended
    • For pure bursitis.



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