Dawbarn Sign for Subacromial Bursitis

Dawbarn Sign is used to diagnose subacromial bursitis of the shoulder, where pressure is applied over subacromial space while passively abducting the arm.

How do you perform Dawbarn Sign?

While further abducting the patient’s moderately abducted arm with one hand, the examiner palpates the anterolateral subacromial space with the other hand.

The examiner exerts additional focal subacromial pressure while passively abducting the patient’s arm up to 90°.

See Also: Rotator Cuff Of the Shoulder

What does a positive Dawbarn Sign mean?

Subacromial pain that decreases with abduction suggests bursitis or rotator cuff lesion.

In abduction, the deltoid glides over the margin of the subacromial bursa, reducing the pain.

Subacromial Bursitis Sign:

Diagnosis of shoulder pains of uncertain etiology.

The examiner palpates the anterolateral subacromial region with his or her index and middle fingers. The examiner can expand the subacromial space by passively extending or hyperextending the patient’s arm with the other hand and pressing the humeral head forward with the thumb. This also allows palpation of the superior portions of the rotator cuff and its insertions into the greater tubercle of the humerus.

Localized tenderness to palpation in the subacromial space suggests irritation of the subacromial bursa but can also be a sign of a rotator cuff disorder.

Shoulder Bursae Anatomy

The shoulder contains a series of bursae.

Communicating structures include the subscapular and subcoracoid bursae and the subdeltoid bursa with its subacromial extension. Together, they form the “subacromial accessory joint” and ensure smooth motion between the rotator cuff and the acromion and acromioclavicular joint that lie superficial to it.

Pathologic processes in the shoulder cause swelling of the bursal walls, thus provoking pain by further narrowing the subacromial space.

Bursitis

Bursitis is a swelling or inflammation of a bursa, which is a synovium-lined, sac-like structure found throughout the body near bony prominences and between bones, muscles, tendons, and ligaments. 

When bursitis occurs, the bursa enlarges with fluid, and any movement against or direct pressure upon the bursa will precipitate pain for the patient. 

There are many causes of bursitis, including:

1. overuse injury,
2. infectious disease,
3. trauma,
4. inflammatory disorders.

References

1. Rosenberg, Nahum. (2021). Diagnostic Value of Frequently Implemented Provocative Tests in the Assessment of Shoulder Pain – A Glimpse of Current Practice. Medicina. 57. 221. 10.3390/medicina57030221. LINK
2. Williams CH, Jamal Z, Sternard BT. Bursitis. [Updated 2021 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513340/
3. Clinical Tests for the Musculoskeletal System 3rd Edition.
4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.