Subacromial bursitis and shoulder pain: Exploring the predictors for a negative anaesthetic response


  • Sarah Betteridge Advance Physiotherapy Christchurch, New Zealand
  • Angela Cadogan Advance Physiotherapy, Christchurch, New Zealand
  • Hemakumar Devan Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, New Zealand



Bursitis, Diagnostic accuracy, Local Anaesthetic, Sensitivity and Specificity, Shoulder Pain


The aim of this retrospective cross-sectional study was to (1) investigate the association between the presence of subacromial bursal pathology and response to subacromial anaesthetic injection; (2) identify variables that are predictive of a negative anaesthetic response; and (3) calculate diagnostic accuracy of these predictors. A total of 208 people with shoulder pain referred from primary care received an ultrasound guided local anaesthetic injection into the subacromial bursa following standardised clinical examination. Pain was recorded on a visual analogue scale immediately prior to and within 15 min post-anaesthetic injection. No difference in pain reduction post injection was found between those with and without bursal pathology (p < 0.05). Five potential predictors of a negative anaesthetic response were identified, but did not reach statistical significance. Clusters of three of the five predictors (high occupational shoulder demands; high or low sport/recreational shoulder demands; no current history of night pain; loss of passive external rotation range of motion of more than 30° and shoulder pain reproduced on cervical spine testing) may have clinical relevance despite not reaching statistical significance. Use of a cluster of any three predictors results in post-test probability of 93% (pre-test probability 69%). The identified predictors may inform clinical decisions regarding the use of injection therapy in those with bursal pathology observed with ultrasound and therefore potentially reduce unnecessary and costly healthcare utilisation.




How to Cite

Betteridge, S., Cadogan, A., & Devan, H. (2023). Subacromial bursitis and shoulder pain: Exploring the predictors for a negative anaesthetic response. New Zealand Journal of Physiotherapy, 50(1), 21–32.