Shoulder Bursitis: Causes, Symptoms, and Treatment

What is Shoulder Bursitis?

Shoulder bursitis occurs when the bursa in the shoulder becomes irritated and inflamed, often due to overuse or injury. The shoulder joint contains several bursae, but the most commonly affected one is the subacromial bursa, which sits between the rotator cuff tendons and the acromion (the bone on the top of the shoulder). This bursa can become inflamed, causing pain and swelling.

Shoulder bursitis is frequently associated with rotator cuff tendinitis or impingement syndrome, as these conditions can lead to compression and irritation of the bursa.

Causes of Shoulder Bursitis

There are several potential causes of shoulder bursitis:

• Repetitive Movements: Activities that involve repeated overhead motions, such as swimming, tennis, painting, or lifting weights, can cause stress on the shoulder and lead to bursitis.

• Injury: A direct blow to the shoulder or a fall onto the shoulder can irritate the bursa, leading to inflammation.

• Overuse: Repeated shoulder use without proper rest or recovery can cause the bursa to become inflamed.

• Aging: As we age, the tissues around the shoulder joint may wear down, leading to increased friction and irritation in the bursa.

• Rotator Cuff Injury: Conditions like rotator cuff tendinitis or tears can increase the risk of shoulder bursitis because of the extra pressure they place on the bursa.

• Underlying Medical Conditions: Conditions like rheumatoid arthritis, gout, and diabetes can make the body more prone to bursitis.

Symptoms of Shoulder Bursitis

The symptoms of shoulder bursitis can vary in severity, but common signs include:

• Pain: The most common symptom is pain in the shoulder, especially when moving the arm overhead or reaching behind the back. The pain may be sharp, aching, or throbbing and often worsens with certain movements.

• Swelling: The shoulder may appear swollen due to the inflammation of the bursa.

• Tenderness: The area around the shoulder may be tender to the touch, especially at the top or side of the shoulder.

• Limited Range of Motion: You may experience difficulty raising the arm or performing certain activities, such as brushing your hair or reaching for objects.

• Night Pain: Many people with shoulder bursitis experience pain that worsens at night, especially when lying on the affected side.

• Weakness: There may be a feeling of weakness in the shoulder, particularly when lifting or carrying heavy objects.

Diagnosing Shoulder Bursitis

To diagnose shoulder bursitis, a healthcare provider will typically conduct a physical exam and may use imaging tests, such as:

• Physical Examination: The doctor will assess the shoulder’s range of motion, check for tenderness, and perform specific tests, such as the Neer test or Hawkins-Kennedy test, which can help identify bursitis and related rotator cuff injuries.

• X-rays: X-rays can help rule out other causes of shoulder pain, such as fractures or arthritis, but they cannot directly show bursitis.

• MRI or Ultrasound: An MRI or ultrasound provides detailed images of the soft tissues around the shoulder joint, including the bursa. These imaging tests are particularly helpful in confirming bursitis and assessing any associated rotator cuff injuries or tears.

• Arthroscopy: In rare cases, the doctor may recommend an arthroscopic procedure to directly visualize the bursa and shoulder joint to confirm the diagnosis and check for other conditions.

Treatment for Shoulder Bursitis

Most cases of shoulder bursitis can be treated effectively with non-surgical methods. The primary goal is to reduce inflammation and relieve pain, and to prevent the condition from becoming chronic. Treatment options include:

Non-Surgical Treatment

• Rest and Activity Modification: Resting the shoulder and avoiding activities that exacerbate the pain is crucial to allowing the bursa to heal. Avoid overhead movements and lifting heavy objects.

• Ice Therapy: Applying ice to the affected shoulder for 15-20 minutes at a time, several times a day, can help reduce swelling and alleviate pain.

• Anti-Inflammatory Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help reduce inflammation and relieve pain.

• Corticosteroid Injections: In cases of severe pain or inflammation, corticosteroid injections may be used to provide quick relief. These injections can significantly reduce inflammation in the bursa, though they are typically used sparingly to avoid potential tendon damage.

• Physical Therapy: Physical therapy plays a key role in strengthening the muscles around the shoulder, improving flexibility, and restoring proper movement patterns. Exercises will focus on strengthening the rotator cuff and scapular muscles, which can help alleviate pressure on the bursa.

• Heat Therapy: After the initial inflammation has subsided, applying heat to the shoulder may help relax muscles and improve blood circulation.

• Posture Correction: Improving posture, particularly during activities that involve repetitive movements, can reduce the risk of further injury and pressure on the bursa.

Surgical Treatment

If conservative treatments do not relieve symptoms or if the bursitis becomes chronic, surgery may be necessary. Surgical options include:

• Bursectomy: In this procedure, the surgeon removes the inflamed bursa to relieve pain and improve shoulder function. This is typically done arthroscopically, meaning the surgeon uses small incisions and a camera to guide the procedure.

• Rotator Cuff Repair: If the shoulder bursitis is caused by or associated with a rotator cuff tear, surgery to repair the torn tendons may be necessary.

• Acromioplasty: If bone spurs or other structural issues are contributing to the shoulder impingement and bursitis, an acromioplasty may be performed. This procedure involves shaving or reshaping the acromion to increase the space around the rotator cuff tendons and reduce pressure on the bursa.

Recovery and Rehabilitation

• Rehabilitation: Whether treated conservatively or with surgery, rehabilitation is crucial to restoring full shoulder function. Physical therapy will focus on strengthening the rotator cuff muscles, improving range of motion, and retraining the shoulder for optimal movement.

• Gradual Return to Activity: It is important to avoid rushing back into physical activity or sports, as doing so may aggravate the bursitis or lead to re-injury. A gradual return to normal activities, guided by a healthcare provider, is essential for long-term recovery.

Preventing Shoulder Bursitis

While it may not always be possible to prevent shoulder bursitis, there are several steps you can take to reduce the risk:

• Warm Up Properly: Always warm up before engaging in physical activity, especially activities that involve repetitive or overhead movements.

• Strengthening Exercises: Regularly perform shoulder-strengthening exercises to improve the strength and stability of the rotator cuff and scapular muscles.

• Avoid Overuse: Take regular breaks during activities that involve repetitive shoulder movements, and avoid overloading the shoulder joint with excessive stress.

• Use Proper Technique: Whether lifting weights, swimming, or playing sports, ensure you are using proper technique to avoid unnecessary strain on the shoulder.

• Maintain Good Posture: Good posture helps keep the shoulder joint aligned and reduces pressure on the bursa.

Expert Care at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, our experienced physiotherapists can help diagnose and treat shoulder bursitis. We offer personalized rehabilitation programs to reduce inflammation, alleviate pain, and restore shoulder function. If you're experiencing shoulder pain or limited mobility, contact us to learn how we can help you recover.