Subacromial subdeltoid (SA/SD) bursitis is one of the most frequent shoulder conditions treated at The Injury Hub. The bursa is a fluid-filled cushion that reduces friction between the rotator cuff tendons, particularly the supraspinatus, and the overlying acromion and soft tissues. When the bursa becomes inflamed, patients often experience sharp pain when lifting the arm or lying on the affected side.

Recent evidence suggests that in many cases the bursa reacts to an underlying supraspinatus tendinopathy rather than being the primary pain source. Strengthening the rotator cuff, especially the supraspinatus, frequently resolves symptoms, supporting the idea that the tendon is often the main driver of pain rather than the bursa itself. Exercise-based therapy has been shown to reduce pain and improve shoulder function across multiple loading protocols and modalities, with no single approach proving superior when exercises are delivered appropriately (Domínguez-Romero et al., 2021; Wu et al., 2025).

Research has also demonstrated that corticosteroid injections into the subacromial bursa can diffuse into the adjacent supraspinatus tendon. This may explain why injections can provide relief even when the tendon is the true source of pain (Metayer et al., 2024). Conversely, there are patients in whom ultrasound reveals marked neovascularity within the bursa while the tendon appears normal, suggesting that in some cases the bursa itself can indeed be the primary pain generator (Merck Manual, 2023).

At The Injury Hub, we adopt an evidence-based and tailored approach. Treatment often begins with hands-on manual therapy to restore movement, combined with progressive strengthening programmes delivered by our Strength and Conditioning coach, Neil, to target the rotator cuff and surrounding stabilisers. If symptoms persist despite these strategies, an ultrasound-guided corticosteroid injection may be considered to provide rapid pain relief and enable further rehabilitation. This integrated approach ensures we address both the immediate pain and the long-term recovery of shoulder function.

References

• Domínguez-Romero JG et al. (2021) Exercise-based muscle-development programmes and their effectiveness in functional recovery of rotator cuff tendinopathy. Diagnostics, 11(3), p.529.

• Wu D et al. (2025) Specific modes of exercise to improve rotator cuff-related shoulder pain. Frontiers in Bioengineering and Biotechnology.

• Metayer B et al. (2024) Ultrasound-guided subacromial corticosteroid injections in rotator cuff tendinopathy. European Radiology.

• Merck Manual (2023) Rotator cuff injury and subacromial bursitis. Merck Manual Professional Version.

Tendinopathy is a condition where a tendon becomes irritated or overloaded, leading to microscopic fibre damage, swelling, and sometimes abnormal new blood vessel growth within the tissue. In the shoulder, tendinopathy most often affects the rotator cuff, a group of four muscles and their tendons, supraspinatus, infraspinatus, subscapularis, and teres minor, which work together to stabilise the joint and allow smooth, controlled movement.

Rotator cuff tendinopathy typically begins with minor overload of the tendon but can progress to structural degeneration and, in some cases, develop into partial or full-thickness tears. The supraspinatus is the tendon most commonly affected, although infraspinatus and subscapularis injuries are also seen, particularly in throwing athletes, overhead workers, and those with poor scapular mechanics. Symptoms usually include a dull ache deep in the shoulder, often aggravated by reaching, lifting, or lying on the affected side. Early-stage tendinopathy may settle quickly after activity, while more persistent cases can lead to constant pain and sleep disturbance (Littlewood et al., 2019; Spallone et al., 2024).

As degeneration advances, partial-thickness tears may occur either on the bursal or joint side of the tendon, and in some cases the tendon can rupture completely. While traumatic tears may follow a sudden injury, many develop gradually over time, particularly in people over the age of 50. Not all tears are painful, and several studies have shown that incidental, asymptomatic tears are common findings on imaging, highlighting the importance of careful clinical assessment alongside scanning (Yamamoto et al., 2022; Van der Graaff et al., 2021).

At The Injury Hub, diagnosis combines thorough clinical assessment with high-resolution ultrasound imaging. Ultrasound is especially useful for dynamic testing, allowing tendons to be observed moving in real time and revealing subtle problems such as impingement beneath the acromion. For more complex cases, or when surgical planning is required, we can arrange same-day MRI imaging.

Treatment depends on severity, symptoms, and patient activity levels. For most, the best results come from progressive rehabilitation aimed at strengthening the rotator cuff and scapular stabilisers, correcting posture, and restoring healthy biomechanics. Our strength and conditioning coach Neil delivers tailored loading programmes that follow the latest research on tendon recovery. Manual therapy, shockwave therapy, and TECAR therapy may complement rehabilitation in patients with persistent symptoms. In degenerative tendinopathy, regenerative injections such as prolotherapy or platelet-rich plasma (PRP) can help stimulate tendon healing (Hurley et al., 2021). Corticosteroid injections can sometimes provide short-term relief but are used cautiously due to the potential risk of weakening tendon tissue with repeated use (Dean et al., 2021).

Surgery is usually considered for large, acute tears in active individuals, or when non-surgical management has failed despite dedicated rehabilitation. Evidence shows that younger patients with traumatic tears often do well following surgical repair, whereas older patients with degenerative tears may achieve equally good or better long-term outcomes through structured exercise programmes (Mallon et al., 2020; Spallone et al., 2024). When surgery is indicated, a carefully phased post-operative rehabilitation plan is critical to restore strength, range of motion, and function.

References

• Dean, B.J.F. et al. (2021) The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review. British Journal of Sports Medicine, 55(5), pp.247–255.

• Hurley, E.T. et al. (2021) The efficacy of platelet-rich plasma and prolotherapy in rotator cuff pathology: a systematic review and meta-analysis. American Journal of Sports Medicine, 49(3), pp.801–811.

• Littlewood, C. et al. (2019) Exercise for rotator cuff tendinopathy: a systematic review and meta-analysis. British Journal of Sports Medicine, 53(4), pp.251–257.

• Mallon, W.J. et al. (2020) Surgical versus nonsurgical management of rotator cuff tears: predictors of outcomes. Journal of Shoulder and Elbow Surgery, 29(6), pp.1103–1112.

• Spallone, S. et al. (2024) Non-operative management of rotator cuff tears: current evidence and future directions. Journal of Clinical Medicine, 13(7), p.1795.

• Van der Graaff, O. et al. (2021) Prevalence of asymptomatic rotator cuff tears: a systematic review and meta-analysis. Shoulder & Elbow, 13(4), pp.305–314.

• Yamamoto, A. et al. (2022) Natural history of asymptomatic rotator cuff tears: a longitudinal study. Journal of Bone and Joint Surgery, 104(12), pp.1101–1109.

Adhesive capsulitis, more commonly known as frozen shoulder, is a condition characterised by progressive restriction of shoulder movement, often accompanied by significant pain. It is more common in women than men and typically occurs between the ages of 40 and 60. In many cases the onset is idiopathic, but it may also develop after shoulder injury, surgery, or in association with medical conditions such as diabetes, thyroid disease, and cardiovascular disorders (Zhu et al., 2020; Kingston et al., 2021).

The hallmark sign is a gradual loss of both active and passive movement, especially external rotation and abduction. Some patients experience severe pain that interferes with sleep and daily activities, while others present with more stiffness than pain. The condition usually follows a self-limiting course lasting 18 months to two years, progressing through the classic phases of freezing (painful loss of movement), frozen (stiffness with reduced pain), and thawing (gradual recovery) (Cho et al., 2019).

Diagnosis is primarily clinical, with imaging used to exclude other causes such as rotator cuff tears or arthritis. Ultrasound may demonstrate thickening of the coracohumeral ligament and capsule, with reduced normal gliding between structures (Hanchard et al., 2021).

Management aims to preserve mobility, reduce pain, and optimise shoulder function. At The Injury Hub, we combine manual therapy, targeted stretching, and joint mobilisation to maintain joint play. Patients are referred to our in-house strength and conditioning coach for controlled mobility and progressive loading programmes. Shockwave therapy can also be effective, particularly in reducing capsular tension and improving range of motion when combined with mobilisation techniques (Notarnicola et al., 2022).

Corticosteroid injections into the glenohumeral joint are often beneficial in the early painful phase, especially when combined with structured rehabilitation (Page et al., 2019). In resistant cases, hydrodilatation under ultrasound guidance can help restore motion (Saltychev et al., 2022). Surgery, such as manipulation under anaesthesia or arthroscopic capsular release, is reserved for persistent cases where conservative care has failed (Sun et al., 2023).

References

• Cho, C.H. et al. (2019) Clinical outcomes of adhesive capsulitis: natural history and factors associated with prognosis. Journal of Shoulder and Elbow Surgery, 28(3), pp.506–513.

• Hanchard, N.C. et al. (2021) Imaging findings in adhesive capsulitis: a systematic review. Musculoskeletal Science and Practice, 54, p.102387.

• Kingston, K. et al. (2021) Risk factors for adhesive capsulitis: a systematic review and meta-analysis. Shoulder & Elbow, 13(2), pp.134–145.

• Notarnicola, A. et al. (2022) Extracorporeal shockwave therapy for adhesive capsulitis: a systematic review and meta-analysis. Journal of Clinical Medicine, 11(7), p.1915.

• Page, M.J. et al. (2019) Corticosteroid injection for shoulder pain: an updated Cochrane review. Cochrane Database of Systematic Reviews, (5), CD007080.

• Saltychev, M. et al. (2022) Effectiveness of hydrodilatation in adhesive capsulitis: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 103(1), pp.118–126.

• Sun, Y. et al. (2023) Arthroscopic capsular release versus manipulation under anaesthesia for frozen shoulder: a meta-analysis. Frontiers in Surgery, 10, p.1129442.

• Zhu, Y. et al. (2020) The epidemiology and risk factors of adhesive capsulitis: a population-based study. BMC Musculoskeletal Disorders, 21(1), p.1–8.

The acromioclavicular joint is located at the very top of the shoulder, where the collarbone (clavicle) meets the acromion of the shoulder blade. Although small, it plays a vital role in fine shoulder movements, particularly when lifting the arm overhead or across the body. Because of its position, the ACJ is exposed to high compressive and shearing forces during repetitive overhead activity, pushing movements, and contact sports (Balke et al., 2018).

ACJ arthritis develops when the protective cartilage lining the joint gradually wears away, causing the bones to rub directly against one another. This can result in pain, swelling, and the formation of bony growths called osteophytes, which may restrict movement and contribute to impingement of the rotator cuff beneath. Although often age-related, the process can be accelerated by trauma such as an AC joint sprain, commonly seen in rugby players, cyclists after a fall, and those sustaining direct blows to the shoulder (Kibler et al., 2019).

Patients usually describe pain localised over the top of the shoulder, sometimes radiating into the neck or upper arm. Symptoms are typically aggravated by bringing the arm across the body, as in fastening a seatbelt, or with activities such as press-ups, bench presses, or overhead lifting. On examination, tenderness directly over the joint and pain provoked by the cross-body adduction test are characteristic features (Pauly et al., 2021).

At The Injury Hub, diagnosis combines clinical assessment with high-resolution ultrasound imaging. Ultrasound can detect joint space narrowing, osteophytes, capsular thickening, and associated swelling, and is particularly valuable as it also allows precise, ultrasound-guided injections into the ACJ when needed (Walther et al., 2020).

Initial management focuses on activity modification, hands-on manual therapy to improve surrounding shoulder mechanics, and progressive strengthening of the rotator cuff and scapular stabilisers to reduce load on the ACJ. Our in-house strength and conditioning coach, Neil, provides tailored rehabilitation programmes based on the latest evidence. In more persistent cases, ultrasound-guided corticosteroid injections can provide significant short- to medium-term pain relief, creating a window of opportunity for further rehabilitation (Corrao et al., 2022).

For advanced arthritis that fails to respond to conservative care, surgical options such as distal clavicle excision (Mumford procedure) may be considered, which have shown good long-term outcomes in carefully selected patients (Nicholson et al., 2023).

References

• Balke, M. et al. (2018) Degenerative changes of the acromioclavicular joint are common in patients with shoulder pain: an ultrasound study. BMC Musculoskeletal Disorders, 19(1), p.112.

• Corrao, M. et al. (2022) Efficacy of corticosteroid injection in acromioclavicular joint osteoarthritis: a systematic review. European Journal of Orthopaedic Surgery & Traumatology, 32(7), pp.1281–1290.

• Kibler, W.B. et al. (2019) Clinical implications of acromioclavicular joint pathology in athletes. Journal of Shoulder and Elbow Surgery, 28(3), pp.417–426.

• Nicholson, G.P. et al. (2023) Long-term outcomes of distal clavicle excision for acromioclavicular joint arthritis. Journal of Bone and Joint Surgery, 105(6), pp.503–512.

• Pauly, S. et al. (2021) Diagnosis and management of acromioclavicular joint osteoarthritis: clinical and imaging findings. EFORT Open Reviews, 6(8), pp.670–679.

• Walther, M. et al. (2020) Role of ultrasound in diagnosis and treatment of acromioclavicular joint osteoarthritis. Skeletal Radiology, 49(10), pp.1595–1603.

Biceps tendinopathy, most often affecting the long head of the biceps (LHB) tendon, is a common cause of pain at the front of the shoulder. The LHB originates from the top of the shoulder socket at the supraglenoid tubercle and passes through the bicipital groove at the front of the humerus before joining the biceps muscle. In addition to contributing to elbow flexion and forearm supination, it plays an important role in dynamically stabilising the shoulder joint (Nguyen et al., 2021).

Irritation or degeneration of the tendon may occur gradually as a result of repetitive overhead activity, poor shoulder mechanics, or in association with other shoulder pathologies such as rotator cuff tears or labral injuries. Patients typically describe a deep aching pain at the front of the shoulder, sometimes radiating into the upper arm. Clicking, snapping, or catching sensations may also be reported during movement (Abdelrahman et al., 2020).

Ultrasound is particularly effective for evaluating the LHB tendon. It can visualise thickening, swelling, partial tearing, sheath inflammation, or instability of the tendon as it passes through the bicipital groove. Dynamic ultrasound also allows real-time assessment of subluxation or dislocation, which is not always apparent on static imaging (Lee et al., 2023).

Management usually begins with a progressive loading programme designed to improve tendon capacity while addressing underlying mechanical issues such as scapular control and rotator cuff strength. Hands-on manual therapy and shockwave may also be used to reduce symptoms and improve tendon function. In more persistent cases, regenerative treatments including platelet-rich plasma (PRP) or prolotherapy may help stimulate tendon healing (Hurley et al., 2021). For complete ruptures or cases of severe instability, surgical referral may be required, particularly in younger or athletic patients (Watson et al., 2024).

References

• Abdelrahman, H. et al. (2020) Long head of biceps tendon pathology and associated lesions: diagnosis and management. Journal of Clinical Orthopaedics and Trauma, 11(5), pp.859–866.

• Hurley, E.T. et al. (2021) The efficacy of platelet-rich plasma and prolotherapy in tendon pathology: a systematic review and meta-analysis. American Journal of Sports Medicine, 49(3), pp.801–811.

• Lee, J. et al. (2023) Diagnostic performance of dynamic ultrasound for instability of the long head of the biceps tendon. Skeletal Radiology, 52(4), pp.667–675.

• Nguyen, M.L. et al. (2021) Functional anatomy and clinical relevance of the long head of the biceps tendon. Orthopaedic Journal of Sports Medicine, 9(12), p.23259671211053989.

• Watson, J.N. et al. (2024) Management of long head of biceps tendon pathology: current concepts and future directions. Journal of Shoulder and Elbow Surgery, 33(2), pp.224–233.

The shoulder labrum is a ring of fibrocartilage that lines the rim of the glenoid socket. Its role is to deepen the socket, increase stability, and allow smooth ball-and-socket motion. When the labrum is torn, shoulder stability can be compromised, often causing pain and mechanical symptoms such as catching, locking, or clicking (Patzer et al., 2020).

One of the most common patterns is a SLAP lesion (Superior Labrum Anterior to Posterior), where the upper part of the labrum is damaged. This area also serves as the anchor point for the long head of the biceps tendon, meaning SLAP tears frequently occur in combination with biceps tendinopathy. They are commonly caused by repetitive overhead activity, sudden traction injuries, or a fall onto an outstretched hand (Hsu et al., 2022).

Another well-recognised type is a Bankart lesion, most often associated with shoulder instability following a dislocation. This injury involves the lower front portion of the labrum and is frequently accompanied by capsular stretching or tearing, predisposing the shoulder to recurrent dislocations (Hurley et al., 2021).

At The Injury Hub, high-resolution ultrasound allows us to assess many superior labral tears and associated paralabral cysts in real time, as well as evaluate biceps tendon involvement. While ultrasound is highly effective for superior labral pathology, same-day MRI can be arranged for more complex injuries, recurrent dislocations, or suspected structural instability where greater detail is required (Chen et al., 2024).

Treatment is tailored according to the type of tear, its severity, and the patient’s activity demands. Many patients respond well to progressive rehabilitation programmes designed to enhance rotator cuff and scapular control, improving dynamic stability of the joint. In cases of persistent pain or recurrent instability, particularly in younger athletes, referral to an orthopaedic surgeon may be necessary. Arthroscopic labral repair has shown good outcomes in restoring shoulder stability and enabling return to sport when conservative care alone is insufficient (Frank et al., 2019).

References

• Chen, J. et al. (2024) Advances in imaging of labral pathology: current role of ultrasound and MRI. Skeletal Radiology, 53(2), pp.215–226.

• Frank, R.M. et al. (2019) Outcomes after arthroscopic repair of superior labral anterior-posterior tears in overhead athletes. American Journal of Sports Medicine, 47(5), pp.1173–1181.

• Hsu, A.R. et al. (2022) Mechanisms and risk factors for superior labral anterior posterior (SLAP) tears: current concepts. Journal of Shoulder and Elbow Surgery, 31(12), pp.2536–2545.

• Hurley, E.T. et al. (2021) Management of Bankart lesions and recurrent anterior shoulder instability: a systematic review. Journal of Bone and Joint Surgery, 103(7), pp.654–662.

• Patzer, T. et al. (2020) The role of the glenoid labrum in shoulder stability and biomechanics. Knee Surgery, Sports Traumatology, Arthroscopy, 28(7), pp.2252–2261.

Shoulder osteoarthritis (OA) is a degenerative condition in which the smooth cartilage covering the joint surfaces wears away, allowing the bones to rub against each other. This process leads to pain, stiffness, and reduced range of motion, which often worsens with activity and improves with rest. Although shoulder OA is less common than arthritis of the hip or knee, it can still significantly impact quality of life, making everyday activities such as dressing, reaching overhead, or lifting increasingly difficult (Papalia et al., 2020).

Patients typically report a deep, aching pain in the shoulder, sometimes radiating down the upper arm. Morning stiffness is common, and creaking or grinding noises (crepitus) may occur during movement. OA may develop gradually due to age-related changes, but it can also occur secondary to previous shoulder injuries, instability, or surgery. Because the symptoms can mimic frozen shoulder or rotator cuff pathology, a thorough clinical examination is vital to establish an accurate diagnosis (Chaudhury et al., 2019).

Diagnosis is based on clinical assessment and confirmed with imaging. Ultrasound can demonstrate osteophytes, joint space narrowing, and associated soft tissue changes, while X-ray and MRI provide a more detailed assessment of the degree of joint degeneration (Malik et al., 2021).

Management focuses on preserving mobility, strength, and function. This typically involves targeted exercise, manual therapy, and activity modification. When symptoms persist, injection therapies can be considered. Corticosteroid injections may provide short-term pain relief, while hyaluronic acid injections have been shown to improve lubrication and cushioning within the joint (Colen et al., 2021). In advanced cases that do not respond to conservative treatment, referral to an orthopaedic surgeon for joint replacement may be necessary. Modern shoulder replacement techniques have been shown to restore excellent function and significantly reduce pain, offering patients long-term improvement and enhanced quality of life (Cho et al., 2022; Simovitch et al., 2023).

References

• Chaudhury, S. et al. (2019) Clinical diagnosis and management of glenohumeral osteoarthritis. BMJ, 364, l290.

• Cho, C.H. et al. (2022) Outcomes of total shoulder arthroplasty: long-term results with modern implants. Journal of Shoulder and Elbow Surgery, 31(6), pp.1181–1189.

• Colen, S. et al. (2021) The efficacy of intra-articular hyaluronic acid for shoulder osteoarthritis: a systematic review and meta-analysis. American Journal of Sports Medicine, 49(1), pp.232–240.

• Malik, S.S. et al. (2021) Imaging of glenohumeral osteoarthritis: current concepts and future directions. Skeletal Radiology, 50(11), pp.2141–2153.

• Papalia, R. et al. (2020) The epidemiology and risk factors for glenohumeral osteoarthritis: a systematic review. Journal of Clinical Medicine, 9(8), p.2401.

• Simovitch, R.W. et al. (2023) Reverse and anatomic shoulder arthroplasty: modern outcomes and survivorship. Journal of Bone and Joint Surgery, 105(5), pp.421–430.

Calcific tendinitis of the shoulder occurs when deposits of calcium build up within the rotator cuff tendons, most commonly the supraspinatus. These deposits can irritate the surrounding tissues and cause intense pain, especially during the resorptive phase when the body attempts to break down and reabsorb the calcium. Although the exact cause is not fully understood, it is thought to be linked to reduced blood flow in certain tendon areas and a failed healing response. Calcific supraspinatus tendinitis is most common in people aged 30 to 60 and can occur in both sedentary individuals and athletes (Louwerens et al., 2020).

Symptoms vary depending on the stage of the condition. In some cases, the calcium deposits remain silent and are discovered incidentally on imaging. When symptomatic, patients typically experience sudden, severe shoulder pain that may radiate into the upper arm, often worse at night and with overhead movement. The pain can be so intense during flare-ups that it restricts even the simplest activities, such as dressing or sleeping (Chianca et al., 2018).

Diagnosis is made through clinical examination and confirmed with imaging. Ultrasound is highly effective, showing the size, shape, and consistency of calcium deposits, and also helps identify associated bursitis or rotator cuff irritation. X-ray can also demonstrate deposits clearly, while ultrasound has the advantage of enabling real-time guided treatment (Sansone et al., 2021).

At The Injury Hub, treatment is tailored to the stage and severity of the condition. In the acute painful phase, management may involve rest, anti-inflammatory strategies, manual therapy, and activity modification. For persistent or severe cases, ultrasound-guided injection and lavage (barbotage) can be used to break up and aspirate calcium deposits, often combined with a corticosteroid injection to settle surrounding inflammation. Shockwave therapy has also been shown to accelerate resorption of calcium deposits and reduce pain (Del Castillo-González et al., 2019). In chronic cases, a progressive strengthening programme with our in-house strength and conditioning coach helps restore shoulder mechanics and prevent recurrence. Surgical removal of deposits is rarely required, but may be considered if conservative treatment fails (Cho et al., 2021).

References (Harvard Style)

• Chianca, V. et al. (2018) Calcium deposition in rotator cuff tendinopathy: from diagnosis to treatment. British Journal of Radiology, 91(1087), p.20170255.

• Cho, N.S. et al. (2021) Surgical outcomes of calcific tendinitis of the shoulder: long-term follow-up. Journal of Shoulder and Elbow Surgery, 30(2), pp.259–266.

• Del Castillo-González, F. et al. (2019) Effectiveness of extracorporeal shockwave therapy in calcific tendinopathy of the shoulder: a meta-analysis. Journal of Orthopaedic Surgery and Research, 14(1), p.209.

• Louwerens, J.K. et al. (2020) The epidemiology of calcific tendinitis of the rotator cuff: incidence, risk factors, and clinical presentation. BMC Musculoskeletal Disorders, 21(1), p.248.

• Sansone, V. et al. (2021) Ultrasound-guided percutaneous treatment of rotator cuff calcific tendinopathy: clinical and radiological results. Skeletal Radiology, 50(1), pp.151–160.