Could You Have
Shoulder Bursitis?

Shoulder bursitis is a common source of shoulder joint pain. What is bursitis of the shoulder? How is it different than shoulder tendonitis? If you have bursitis, what are the best treatment options? Learn more about this condition and what you can do to help reduce your shoulder pain.


Shoulder Anatomy

The shoulder is comprised of three bones: the humerus, scapula and calvicle. The shoulder is a very mobile joint and receives minimal stability from the bony structure. The soft tissue of the shoulder, including the rotator cuff muscles and joint capsule, function to help provide stability to the mobile shoulder joint.

shoulder anatomy


There are a number of bursae that are also located around the shoulder complex. A bursa is fluid filled sacs that functions to provide cushioning around joints. The largest and most commonly injured bursa of the shoulder is called the subacromial bursa. This bursa is located between the arch of the acromion above and the humerus below.


What is Shoulder Bursitis?

Any type of an ‘itis’ refers to inflammation. In the case of subacromial bursitis, it is the bursa itself that has become inflamed.


What Causes Bursitis?

Shoulder bursitis can be caused by acute trauma or by chronic irritation. Acute trauma can come in the form of landing on the outside of the shoulder or in the form of an incident of performing a new activity. An example of acute bursitis from an activity can be something as using your arm to pain a room. This activity creates stress on the bursa because it is new and stresses the shoulder in a unique way.

In addition to whether the bursitis is caused by an acute incident or a chronic irritation, bursitis is also impacted by shoulder mechanics. The most common issues that can affect the shoulder bursa is a shoulder that is stiff (hypomobile) or a shoulder that is weak (creating hypermobility).

shoulder joint pain

When a shoulder is stiff, specifically the joint capsule of the shoulder, the shoulder will move in an abnormal fashion. Most commonly, when the joint capsule is stiff, the shoulder with have a tendency of rising up into the subacromial space when the arm is lifted overhead. When this occurs, the head of the humerus will pinch the bursa, causing it to become inflamed. The most extreme example of stiffness of the shoulder is called frozen shoulder.

Inflammation of the bursa can also be caused by shoulder weakness. The shoulder obtains much of its stability through the function of the rotator cuff muscles. When the rotator cuff becomes weak, the shoulder becomes more unstable. Again, when the arm is lifted overhead, if the rotator cuff does not function in keeping the head of the humerus in the correct position, it will elevate up, pinching the bursa.


Signs and Symptoms

The typical symptoms associated with bursitis include shoulder joint pain. shoulder stiffness, weakness, and limitation in the ability to raise the arm overhead. Functional activities such as getting a shirt on and off, combing your hair, and reaching up into a cabinet can be painful and limited.

One challenge in diagnosing bursitis is that the signs and symptoms are similar to that of shoulder tendonitis. Some general practitioner physicians will often use either terms interchangeably. It is also not uncommon to have both conditions occurring at the same time. If the rotator cuff tendons become inflamed, they will be unable to function in keeping the head of the shoulder in the correct position. This will in turn allow the bursa to become pinched leading to the bursa also becoming irritated. The good news is that bursitis and tendonitis are treated in a very similar fashion.


Typical Treatment

Treatment for all inflammatory conditions first starts with reducing the inflammation. This can be accomplished by utilizing ice therapy. Apply ice to the shoulder, 10 minutes at a time, a few times a day. Anti-inflammatory medication can also be effective in reducing inflammation (consult your doctor regarding medications). And in some cases, steroid injections are utilized to reduce inflammation. In addition, physical therapy modalities such as phonophoresis, iontophoresis, and interferential stimulation can help to reduce joint inflammation.

In addition to reducing joint inflammation, treatment must also include addressing the underlying cause (stiffness or weakness). Physical therapy is greatly effective in helping to restore normal joint mobility. Manual joint mobilizations and shoulder stretches can effectively eliminate shoulder stiffness. A physical therapist can also evaluate the extent in which rotator cuff weakness has contributed to the shoulder bursitis and prescribe a strengthening program to address areas of limited strength.


Surgery

The good news about shoulder bursitis is that it rarely requires surgery. Conservative treatments to reduce inflammation, restore shoulder mobility, and normalize shoulder strength are greatly effective in reducing shoulder joint pain and restoring function. Only in significant cases in which conservative therapy has failed, or the bursa has become infected is surgery ever considered.


Summary

• Shoulder bursitis is inflammation of the bursa, most commonly the subacromial bursa of the shoulder.

• Bursitis is caused by shoulder stiffness or rotator cuff weakness, both resulting in pinching of the bursa.

• Typical treatment includes reducing inflammation, restoring normal shoulder mobility, and restoring rotator cuff strength.

• Surgery is rarely required in the treatment of bursitis.

If you do have bursitis of the shoulder, the quicker you begin treatment the faster your symptoms and function will improve. Begin using ice immediately and see your doctor and physical therapist to help resolve your symptoms quickly.

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