cyriax diagnostic system

What's the difference between an acute and a chronic shoulder bursitis?


The clinical image of a chronic and an acute subdeltoid bursitis in the shoulder is totally different. 

>>> Click here to find out more about differential diagnosis and clinical reasoning in the shoulder

The chronic bursitis, or "bursitis light", is far more frequent.

The patient describes a very typical history: 

mostly ,without any injury, in the course of two or three days he loses almost all capacity to abduct his arm and suffers from constant pain within the C5-dermatome. The patient is mostly younger than 65 years.


In an acute subdeltoid bursitis the non-capsular pattern is clinically obvious : active and passive abduction is severily limited and painful, both rotations are less limited, but also quite painful. Several resisted tests such as abduction and lateral rotation could also provoke some pain (because of the compression on a inert structure during this contraction).

Palpation for tenderness is usually very obvious. The palpable subdeltoid part of the bursa, as a whole, is very tender.

A painful arc cannot be elicited because of too much pain limiting the abduction.

A chronic subdeltoid bursitis is not an acute bursitis which became chronic. 

I rather prefer to talk about a "bursitis light".

in the acute bursitis there is an inflammation of the complete bursa where as in the chronic one there is more an irritation of some part of the bursa : the palpable subdeltoid or the non-palpable subacromial part.

The main symptom is a clear painful arc with end range pain on passive movements (elevation and rotations): mostly, none of the resisted movements usually hurt, although it is possible that resisted abduction and/or lateral rotation are painful, due to an extra compression on the bursa.

Note : repeat the resisted tests from a lying position and if those tests are negative from this position, and positive in the standard standing position, then you can exclude tendinous involvement.

Place comment