Subacromial bursitis: current evidence and future directions in injection-based therapies–A narrative review

OBJECTIVE: To review the anatomical and physiological characteristics of subacromial bursitis (SAB), clarify its pathogenesis and commonly used imaging diagnostic methods, and summarize the clinical efficacy, current application status, and future research directions of various injectable agents for SAB. METHODS: This narrative review performed a non-systematic literature search in PubMed and Web of Science for injection therapies for SAB and related conditions , focusing on clinical trials and systematic reviews. RESULTS: Corticosteroids (CS) remain the most widely used, providing robust short-term pain relief but with potential long-term complications. Randomized controlled trials suggest hyaluronic acid, nonsteroidal anti-inflammatory drugs, and hypertonic glucose offer alternative or adjunctive options. Emerging biologics like platelet-rich plasma (PRP) and interleukin-1 antagonists show promise but low-quality evidence. Ultrasound guidance enhances injection precision, and combining injection with physical rehabilitation optimizes outcomes. CONCLUSION: The choice of injectable agent requires balancing CS's rapid effects against safer but less established alternatives. Future research should validate PRP, HA, IL-1Ra, and hypertonic glucose via large RCTs, develop combination strategies (e.g., CS+HA), integrate advanced ultrasound techniques (e.g., hydrodissection), and identify patient-specific factors (e.g., inflammatory endotypes, concomitant rotator cuff pathology) for personalized treatment.