Diagnosing Shoulder Bursitis

Diagnostic Imaging Algorithm

The American College of Radiology recommends that for suspected shoulder bursitis with noncontributory radiographs, both MRI without contrast and ultrasound are equally appropriate first-line imaging modalities, with the choice depending on local expertise availability, rated 9/9 1, 2
The American College of Radiology suggests always obtaining plain radiographs first to exclude bony abnormalities, fractures, calcific tendinitis, and acromial morphology issues 3
Standard views for initial radiographs include anteroposterior (internal and external rotation) and axillary or scapula-Y views, as recommended by the American College of Radiology 4, 3
MRI without contrast is advantageous for visualizing subacromial bursa inflammation, evaluating concurrent rotator cuff pathology, and assessing muscle atrophy and fatty infiltration, with a rating of 9/9 2, 3
Ultrasound is beneficial for real-time dynamic assessment, guiding therapeutic injection simultaneously, and has no radiation and lower cost, with a rating of 9/9 1, 2
The American College of Radiology notes that calcific tendinitis and bursitis are covered under chronic shoulder pain protocols, not acute shoulder pain, as per the 2025 ACR guidelines 6, 4

When infection is suspected, the American College of Radiology recommends performing bursal aspiration with ultrasound or fluoroscopic guidance, both rated 9/9 5