Dawbarn’s sign is a clinical indicator of acute subacromial bursitis, characterized by pain elicited on palpation of the acromial process.

• Pain is typically felt when the arm is at rest by the patient’s side.

• The discomfort disappears or diminishes when the patient abducts the arm, reflecting relocation of the subacromial bursa and reduced pressure.

• This sign helps differentiate subacromial bursitis from other shoulder pathologies, such as rotator cuff tears or glenohumeral joint disorders.

Pathophysiology

• The subacromial bursa lies between the supraspinatus tendon and the acromion.

• Inflammation (bursitis) leads to painful compression between the humeral head and acromion.

• When the arm is abducted, the bursa moves away from the acromion, relieving pressure and reducing pain.

• Mechanical irritation during palpation at rest reproduces the characteristic discomfort.

Examination Technique

Patient Positioning

• Patient sits or stands with the arm relaxed at the side.

Palpation Procedure

• Palpate the lateral and anterior aspect of the acromial process.

• Assess for tenderness, swelling, or warmth.

• Ask the patient to slowly abduct the arm while continuing palpation.

• Observation: A positive Dawbarn’s sign occurs when pain diminishes or disappears on abduction.

Clinical utility

• Diagnosis of subacromial bursitis: Positive sign supports inflammatory involvement of the subacromial bursa.

• Differential assessment: Helps distinguish bursitis from rotator cuff tendonitis or glenohumeral arthritis, where pain persists throughout motion.

• Monitoring response to treatment: Pain reduction with abduction may help gauge functional improvement after therapy.

Differential Diagnosis

Pediatric considerations

Rare in children; if present, consider trauma or infection as causes of subacromial bursitis.

Geriatric considerations

• More common due to degenerative changes and rotator cuff degeneration.

• Must differentiate from shoulder impingement syndrome or rotator cuff tears.

Limitations

• Pain perception is subjective; patient cooperation is essential.

• May be negative in chronic bursitis with fibrotic changes or in severe rotator cuff pathology.

Patient counseling

• Explain that the sign helps identify inflammation of a shoulder bursa.

• Advise rest, activity modification, and anti-inflammatory therapy.

• Emphasize the importance of gradual rehabilitation exercises to restore function.

Conclusion

Dawbarn’s sign is a useful clinical indicator of acute subacromial bursitis, characterized by pain on palpation that improves with arm abduction. Proper technique and interpretation aid in diagnosis, differentiation from other shoulder disorders, and monitoring of therapeutic outcomes.

References

1. Dawbarn D. Clinical features of subacromial bursitis. J Bone Joint Surg Br. 1955;37-B:55–62.

2. Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder. J Bone Joint Surg Am. 1972;54:41–50.

3. Michener LA, et al. Subacromial bursitis: pathophysiology, diagnosis, and management. J Orthop Sports Phys Ther. 2003;33(12):548–559.

4. Magee DJ. Orthopedic Physical Assessment. 6th ed. Philadelphia: Saunders; 2014.

5. Beard DJ, et al. Shoulder pain and subacromial bursitis: diagnosis and management. BMJ. 2003;326:928–931.