Shoulder pain is one of the most frequent musculoskeletal complaints, affecting people across all ages and activity levels. Among its many causes, bursitis, inflammation of the bursa, is both common and easily overlooked. Fortunately, ultrasound provides a quick, accurate, and radiation-free method for assessing bursitis, helping clinicians confirm diagnosis and guide appropriate treatment.

Understanding Shoulder Bursitis

A bursa is a small fluid-filled sac that cushions movement between tendons, muscles, and bones. The subacromial-subdeltoid bursa, located beneath the acromion and deltoid muscle, is the structure most commonly affected in shoulder bursitis.

When inflamed, this bursa can fill with excess fluid, causing pain, swelling, and restricted movement, symptoms often mistaken for rotator cuff tears or tendonitis.

Common causes include:

• Repetitive overhead activities (e.g. painting, swimming)

• Direct trauma or pressure

• Degenerative changes in the shoulder joint

• Poor posture or biomechanical stress

Patients typically present with:

• Pain on lifting or rotating the arm

• Tenderness over the outer shoulder

• Night-time discomfort, especially when lying on the affected side

• Decreased range of motion

Because bursitis shares features with other shoulder pathologies, imaging is often required for accurate diagnosis.

The Role of Ultrasound in Diagnosis

Ultrasound is an ideal tool for evaluating shoulder bursitis due to its real-time dynamic imaging capabilities. It allows detailed visualisation of the bursa and surrounding soft tissues.

Ultrasound findings may include:

• Bursal fluid collection: appearing as an anechoic or hypoechoic area between the deltoid and rotator cuff.

• Bursal wall thickening: a sign of chronic inflammation.

• Hypervascularity on Doppler: indicating active bursitis.

• Associated findings: such as rotator cuff tendinopathy or calcific deposits.

Unlike MRI, ultrasound enables functional assessment, the sonographer can observe movement of the shoulder joint during scanning, identifying impingement or friction that aggravates inflammation.

Advantages of Ultrasound for Shoulder Bursitis

• Radiation-free and cost-effective compared to CT or MRI.

• Immediate results, allowing for same-day clinical decisions.

• Dynamic evaluation of shoulder mechanics.

• Guidance for therapeutic injections, such as corticosteroids, to target inflammation precisely.

These benefits make ultrasound the first-line imaging choice for suspected bursitis in both general practice and physiotherapy referrals.

Treatment and Follow-Up

Once confirmed, treatment typically includes:

• Rest and avoidance of aggravating movements

• Anti-inflammatory medications

• Physiotherapy for posture correction and strengthening

• Ultrasound-guided corticosteroid injection in persistent cases

Follow-up ultrasound can be used to monitor resolution of bursal inflammation and evaluate response to therapy.

Expert Shoulder Ultrasound for Accurate Bursitis Diagnosis

Shoulder bursitis is a frequent yet treatable cause of shoulder pain. Through high-resolution ultrasound, clinicians can visualise inflammation, confirm diagnosis, and guide targeted interventions, all in a single visit.

At Ultrasound Insight, our musculoskeletal sonographers combine precision imaging with patient-centred care to support effective diagnosis and recovery.

Book a shoulder ultrasound today and take the first step towards understanding and managing your shoulder pain.