Subacromial bursitis of the shoulder in Vienna
What was formerly called shoulder impingement is usually an irritated, thickened bursa beneath the acromion, the bony roof of the shoulder. If you have searched for “shoulder impingement”, this is almost always the problem you mean: pain when lifting the arm and at night. At my practice in Vienna-Döbling I assess the cause with ultrasound and discuss with you the treatment that fits the findings.
In short
Shoulder impingement, now called subacromial pain syndrome or subacromial bursitis (Bursitis subacromialis), is a painful irritation of the bursa and of the rotator cuff tendon beneath it, under the acromion. Typical signs are pain when lifting the arm sideways and overhead, especially through a middle arc of movement, and night pain when lying on the affected side. The assessment is made with the conversation, the clinical examination and ultrasound in the practice, which shows the thickened bursa. Treatment is usually conservative first, with adjusted load, physiotherapy and, where needed, an ultrasound-guided injection into the bursa. If the symptoms persist, the inflamed bursa can be removed arthroscopically and a cause such as a tendon tear treated at the same time.
What is subacromial bursitis?
Between the acromion and the tendon cap of the rotator cuff lies a flat bursa, the subacromial bursa. It is a thin gliding layer: as the arm rises, the tendon slides with it beneath the bone. Repeated strain, for example from overhead work or sport, or damage to the tendon beneath can inflame this bursa. It thickens, and every movement that carries it under the acromion hurts.
Why the term impingement is falling out of use
The word impingement comes from an older concept: as the arm is raised, the tendon was thought to be mechanically pinched between the humeral head and the bony acromion, caused by a bone spur on the underside of the acromion. From this followed the idea of making room by shaving bone off the underside of the acromion — subacromial decompression.
Today the view is more differentiated, and the term used is subacromial pain syndrome. The pain usually comes from the irritated, thickened bursa and from the rotator cuff tendon beneath it; the shape of the bone alone does not, as a rule, explain the symptoms. Routinely removing bone is therefore no longer regarded as the standard answer. Yet the old term lives on in everyday speech and many reports — if “impingement” appears on yours, this is usually the picture it refers to.
Calcific tendinitis, tendon tears and frozen shoulder
Bursitis rarely stands alone. In calcific tendinitis the calcium deposit in the tendon can irritate the bursa directly above it. A tear of the rotator cuff is often accompanied by bursitis; the tendon then determines how treatment proceeds. A frozen shoulder needs to be told apart: it also hurts at night, but the shoulder stays stiff even when I move the arm for you — with bursitis it usually moves freely when guided.
Typical symptoms
- Pain when lifting sideways — especially through a middle arc of movement (the painful arc)
- Overhead trouble — washing your hair, reaching a high shelf, overhead sport
- Night pain — lying on the affected shoulder is difficult
- Radiating pain — the pain spreads into the outer upper arm
- Strength mostly preserved — marked weakness points rather to damage to the tendon
- Free movement when guided — it is the pain that holds you back, not a shrunken capsule
How I make the diagnosis
First I ask how long the shoulder has been hurting, which movements trigger the pain, what you do overhead at work and in sport, and how you are sleeping. In the clinical examination I use movement and function tests to check whether a painful arc appears when you lift the arm sideways, how strong the individual tendons are and whether the shoulder moves freely when guided. With ultrasound in the practice, in motion as well, I see whether the bursa is thickened, what state the tendon beneath it is in and whether there is a calcium deposit. If needed, I arrange an X-ray or MRI outside the practice, for instance when a tendon tear is suspected. Please bring your e-card, previous findings and any images you have; you do not need a referral.
Treatment: conservative first, where the findings allow
The aim of treatment is to settle the irritation of the bursa, relieve the pain and preserve mobility. If the examination shows bursitis without a tendon tear, I begin conservatively. If there is a fresh tear of the tendon beneath, the approach follows the tendon, and I discuss surgery earlier.
- Adjusting load — temporarily cutting back on the overhead movements that trigger pain, without immobilising the arm
- Physiotherapy and exercise therapy — in-house at the Orthozentrum Döbling, in the same building as my practice
- Ultrasound-guided injection — a medication placed under direct vision at the irritated bursa, not into the tendon; more on ultrasound-guided injection
- Ultrasound follow-up — at check-ups I look at bursa and tendon on the image again; more on ultrasound in the practice
If the tendon insertion is irritated as well, or a calcium deposit is present, further procedures come into question, such as shockwave therapy. It is then aimed at the tendon or the deposit, not at the bursa itself. Which measures make sense depends on the findings and on your restrictions in daily life.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. Details are on the page about the private practice and billing.
When an operation is necessary
If the symptoms persist despite consistent conservative treatment, an operation comes into question. I operate arthroscopically through small incisions and remove the inflamed bursa (bursectomy). If there is an underlying cause, I treat it in the same session: a torn rotator cuff tendon is repaired, a calcium deposit cleared out. I remove a bone spur on the acromion only when the findings in the individual case call for it, not as a routine step.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
After the procedure the shoulder is moved again early; physiotherapy and exercise therapy at the Orthozentrum Döbling take over the rebuilding, and I carry out the check-ups myself. How quickly things progress depends on whether only the bursa was removed or a tendon was repaired as well. Whether surgery is an option for you at all is something we discuss together on the basis of the examination and imaging.
Frequently asked
Frequently asked questions about bursitis and impingement
Impingement is the older name for pain beneath the acromion when the arm is raised. It was once thought that the tendon was pinched against the bone there. Today the term is subacromial pain syndrome: the pain usually comes from the irritated, thickened bursa (subacromial bursa) and from the rotator cuff tendon underneath it. Typical are pain on lifting the arm sideways, overhead and at night.
In everyday use, mostly yes. Anyone who arrives with a diagnosis of impingement almost always has an irritated bursa beneath the acromion, often together with an irritated tendon. The word impingement, however, describes an outdated idea — the tendon being trapped by bone — whereas bursitis names the finding I see on ultrasound. Whether a tendon tear or a calcium deposit is also present is what the examination clarifies.
As a rule, not as the first step. I treat bursitis without a tendon tear conservatively first: adjusting load, physiotherapy at the Orthozentrum Döbling and, where needed, an ultrasound-guided injection. If the symptoms persist despite this, I remove the inflamed bursa arthroscopically and treat a cause such as a tendon tear at the same time. I do not routinely trim bone beneath the acromion. We make the decision together, based on the findings.
When you lie on the affected side, your body weight presses the humeral head up against the acromion, and the irritated bursa in between comes under pressure. An arm resting above the head narrows the space as well, so many people wake when they turn over. Night pain also occurs with a rotator cuff tear, calcific tendinitis or a frozen shoulder, though; the examination shows which cause applies.
As the arm is raised sideways, the rotator cuff tendon and the bursa above it glide beneath the acromion. If the bursa is thickened, this passage hurts — typically through a middle arc of movement, while lifting below and right at the top is easier. This painful arc is a clue, not proof; ultrasound and function tests show which structure is involved.
In calcific tendinitis a calcium deposit sits inside the tendon; in bursitis the bursa above the tendon is irritated and thickened. The two are often linked: the deposit can irritate the bursa directly above it, and when it dissolves, calcium material can escape into the bursa. Ultrasound and X-ray show whether a deposit is present — and that determines which treatment comes into question.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. If surgery is needed, direct settlement with a supplementary private insurance is possible. You do not need a referral for your first appointment.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.