more severe association of rotator cuff pathology

may require hospital admission for pain control.

It is the only inflammatory disorder around the shoulder joint where localised tenderness is a reliable sign.

manage with

• Strong analgesics (e.g. paracetamol and codeine)
• Large local injection of 5–8 mL of local anaesthetic into and around the bursa just beneath the acromion, followed immediately by 1 mL of corticosteroid (long-acting) into the focus of the lesion