While almost all rotator cuff tears have an associated subacromial bursitis, the bursa can become inflammed without the cuff being torn.  This often happens with overuse or even with sleeping in an abnormal position.  The diagnosis is often made from just the history and several physical exam findings; usually, the rotator cuff is strong, but the shoulder is clearly irritated despite normal or near normal motion.  Treatment is only very rarely surgical; an injection into the area with corticosteroid and a very brief course of physical therapy will ususally solve the problem.   If not, MRI is used to rule out an associated rotator cuff tear.

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