What is shoulder bursitis

We are often asked what is Shoulder bursitis ?

Many of our patients will have this finding on an ultrasound for shoulder pain.

Pain with sleeping is one of the common symptoms- explained here in our Patient resource Waking with Shoulder Pain

Anatomy and causes

Shoulder bursitis is an inflamed shoulder bursa. A bursa is a fluid filled sac that helps to reduce friction between soft tissues and bones in a joint.

However a diagnosis of bursitis may be an accompanying feature rather than the primary driver of the pain. It often co exists with other shoulder pathology such as rotator cuff tendinopathy

A classic shoulder bursitis usually involves the subacromial bursa. This commonly irritated bursa is located in the subacromial space and is therefore termed subacromial bursitis. The pain is usually related to primary or secondary impingement of the bursa between the rotator cuff tendons and the acromion. It may be due to your anatomy and structural narrowing of the space and bursa or the impingement can occur if you have a dynamically unstable shoulder.

This means that there can be a combination of excessive joint movement, ligament laxity and muscular weakness around the shoulder joint. The impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity.When your rotator cuff fails to work normally, it is unable to prevent the head of the humerus (upper arm) from riding up into the sub-acromial space, causing the bursa and / or tendons to be squashed.

Shoulder pain can also be referred from you neck- This Neck Guide can help differentiate where your pain may be coming from.

Shoulder bursitis may be Predisposed by:

Degeneration of the AC joint, bony anomaly or osteophytes (spurs), poor shoulder biomechanics, poor posture, muscular imbalances, muscular tightness, capsular restrictions, incorrect motor patterns, poor lifting or throwing techniques and or repeated overhead activities.

Repeated minor trauma such as overuse of the shoulder joint and muscles or a single more significant trauma such as a fall may then trigger the process.

Signs and symptoms of subacromial bursitis can include

  • Often there is a painful arc of abduction, this refers to pain when you hold your arm straight out to the side that decreases as you move higher or lower thus Pain most intense by using arm for activities at or above shoulder height
  • Discomfort and restriction of full shoulder movements.
  • Gradual onset of pain progressively worsening in intensity over weeks or months following or during repetitive activity.
  • Pain may have rapid intense onset if bursitis caused by significant trauma such as fall.
  • Location of pain is typically on the outer aspect of the shoulder and often refers down the arm to the mid humerus and can spread down to elbow and wrist.
  • Patients often describe a tightening sensation around their upper arm.
  • Pain aggravated when lying directly on affected side but also can be when lying with affected arm hanging over the body when lying on unaffected side.
  • At rest shoulder often feels more comfortable to be held across the body as though wearing a sling or supported by arm of a chair.
  • Feeling of inability to lift arm (and weights) away from body due to pain inhibiting the muscles and causing a sensation of weakness
  • Typically the supraspinatus muscle can be excessively tight.

Making a Diagnosis

Your physiotherapist will perform a series of special tests on your shoulder which combined with your history of onset of symptoms will indicate the diagnosis of shoulder bursitis. This can be confirmed with medical imaging if needed

Physiotherapy treatment can include:

  • Rest from aggravating movements.
  • Ice.
  • Soft tissue mobilisations, joint mobilisations, Taping and appropriate stretches will aim to take pressure off the bursa.
  • Trigger point work to help release tight muscles
  • Restoration of correct posture and movement patterns.
  • Strengthening the rotator cuff stabilisers to ensure the shoulder moves properly.
  • Strengthening scapula stabilisers ensuring the shoulder blade moves as required and gains the required upward rotation movement to help decrease subacromial compression
  • Strengthening the core posture to ensure the shoulder is not compensating for a dysfunction further down the body.
  • Functional rehabilitation or sports and task specific training.
  • Sometimes patients with bursitis will have tried various treatments without success. This may indicate an incorrect diagnosis was made and treatment was done inappropriately such as strengthening of the rotator cuff before muscular tightness and capsular restrictions were addressed. A cortisone injection may settle the pain temporarily, but the problem resumes if the underlying factors are not addressed.
  • As with all injuries it is important to address the entire functioning body because for example; if the bursitis was actually being caused by a stiff thoracic spine putting excessive stress on the shoulder, soft tissue release or rotator cuff strengthening will not completely address the problem.
  • Strengthening is vitally important to ensure the correct shoulder stabilisation is occurring through all your movements however these need to be brought in at the correct time and they need to be relevant to your function, be it your job or your sport

Speak with one of our physiotherapists experienced in the management of Shoulders, impingement and bursitis. Call us on 83462000 for Hindmarsh and 83422233 at Prospect.

Neck and shoulder pain are often connected- you're welcome to download our Patient Resource on Managing Neck Pain here: Neck_Pain_Guide

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