Shoulder pain is one of the most common musculoskeletal complaints seen in physiotherapy and general practice. Two diagnoses that are frequently confused are rotator cuff tears and subacromial bursitis. While they can cause very similar symptoms, the underlying problem and optimal treatment approach can be quite different (Lewis, 2016).

Understanding the difference helps guide appropriate management and prevents unnecessary delays in recovery.

What Is the Rotator Cuff?

The rotator cuff is a group of four muscles and their tendons that stabilise the shoulder and allow lifting and rotation of the arm. A rotator cuff tear occurs when one or more of these tendons becomes partially or fully torn, either due to trauma or gradual degeneration over time (Kuhn, 2009; Yamamoto et al., 2010).

Rotator cuff tears are very common, especially with increasing age, and many people have degenerative changes even before pain starts (Yamamoto et al., 2010).

What Is Bursitis?

A bursa is a small fluid-filled sac that reduces friction between tissues. In the shoulder, the subacromial bursa sits between the rotator cuff and the bony roof of the shoulder. Subacromial bursitis occurs when this structure becomes inflamed, usually due to overload, irritation, or altered shoulder mechanics (Lewis, 2016).

Bursitis is often part of a broader rotator cuff–related shoulder pain presentation rather than a completely isolated condition (Lewis, 2016).

Symptoms They Have in Common

Both conditions can cause:

• Pain with lifting the arm
• Pain with overhead activity
• Night pain (especially when lying on the affected side)
• Reduced shoulder movement

Because of this overlap, it is not possible to tell the difference based on pain alone (Lewis, 2016; Kuhn, 2009).

Key Differences in Presentation

Strength

• Rotator cuff tear: Often associated with true weakness, particularly with lifting or rotating the arm, due to loss of tendon integrity (Kuhn, 2009).
• Bursitis: Usually pain-limited strength, but the muscle can often still produce force once pain is reduced (Lewis, 2016).

Pain Behaviour

• Bursitis: Pain is often more irritable, sensitive to loading, and may fluctuate significantly day to day depending on activity levels (Lewis, 2016).
• Rotator cuff tear: Pain is often associated with specific movements and functional tasks, and weakness is more consistently present (Kuhn, 2009).

Function

• Rotator cuff tear: May cause difficulty lifting objects, reaching overhead, or performing tasks like putting on a shirt or reaching into cupboards (Yamamoto et al., 2010).
• Bursitis: Function is limited mostly by pain rather than true loss of strength (Lewis, 2016).

Can Scans Tell the Difference?

Imaging can help, but it must be interpreted carefully.

• Ultrasound and MRI are both reliable for detecting rotator cuff tears (Dinnes et al., 2003).
• However, many people without pain have rotator cuff tears on imaging, especially over the age of 50 (Yamamoto et al., 2010).
• Likewise, imaging findings of bursitis do not always correlate with pain severity (Lewis, 2016).

This is why clinical examination and functional assessment are just as important as scans.

Why Getting the Diagnosis Right Matters

Treatment approaches differ:

• Bursitis / rotator cuff related pain:
  Usually responds very well to load management, targeted strengthening, and movement retraining (Lewis, 2016).
• Rotator cuff tears:
  Many can still be managed conservatively with physiotherapy, but larger or traumatic tears may require surgical opinion depending on functional loss and patient goals (Kuhn, 2009).

The Big Takeaway

Bursitis is primarily a pain and irritation problem.
Rotator cuff tears involve structural tendon damage and often true weakness.

A thorough physiotherapy assessment is the best way to determine:

• Whether weakness is pain-related or structural
• How much the tendon is contributing
• What the most appropriate treatment plan should be

If You Have Ongoing Shoulder Pain

If your shoulder pain has:

• Not improved
• Is limiting your function
• Is disturbing your sleep
• Or feels weak and unreliable

…a proper assessment is important to guide the right next step. Our physiotherapists are all trained in diagnosing and assessing these conditions. Appointments can be made online or by phone.

References

Dinnes, J., Loveman, E., McIntyre, L., & Waugh, N. (2003). The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: A systematic review. Health Technology Assessment, 7(29), 1–166. https://doi.org/10.3310/hta7290

Kuhn, J. E. (2009). Exercise in the treatment of rotator cuff impingement: A systematic review and a synthesized evidence-based rehabilitation protocol. Journal of Shoulder and Elbow Surgery, 18(1), 138–160. https://doi.org/10.1016/j.jse.2008.06.004

Lewis, J. (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. Manual Therapy, 23, 57–68. https://doi.org/10.1016/j.math.2016.03.009

Yamamoto, A., Takagishi, K., Osawa, T., Yanagawa, T., Nakajima, D., Shitara, H., & Kobayashi, T. (2010). Prevalence and risk factors of a rotator cuff tear in the general population. Journal of Shoulder and Elbow Surgery, 19(1), 116–120. https://doi.org/10.1016/j.jse.2009.04.006

Read more….

To learn more about rotator cuff injuries, check out our blog HERE
To learn more about different types of frozen shoulder check out our blog HERE
To learn more about rotator cuff tears and do if you need surgery or not, check our our blog HERE