Anatomy & Background
Shoulder bursitis is a condition characterized by inflammation of the bursa in the shoulder. When inflammation of the bursa occurs, it results in pain and tenderness, and also limits mobility of the shoulder joint. Shoulder bursitis most often occurs in individuals 40 – 60 years old, although it can also occur in younger individuals as a result of overuse injuries involved with various sports or repetitive activities.
The most common location for shoulder bursitis to occur is in the subacromial space, an area on top of the shoulder that contains the acromio-clavicular joint, coraco-acromial ligament and acromion. This area creates the coracoacromial arch. The subacromial bursa, rotator cuff tendons, and the long head of the biceps tendon pass under this arch. The subacromial bursa is a fluid-filled sac that decreases friction between the rotator cuff muscles and the acromion in the shoulder and protects the rotator cuff from injury when moving under the acromion. If the space becomes narrowed for any reason, rubbing, friction, irritation and inflammation of the bursa can result. As the bursa becomes inflamed, it can thicken, leading to further impingement in the narrow subacromial space and continuing the cycle of pain and inflammation.
Shoulder bursitis is relatively common due to the amount of stress and activity that is placed on the joint, as well as the basic anatomy of the shoulder joint itself. It is typically a repetitive strain injury (RSI) caused by overuse, but can result due to other causes. Causes of shoulder bursitis include:
- Injury to the tendons in the shoulder joint, especially the supraspinatous tendon, that can cause inflammation of the surrounding bursa, resulting in bursitis.
- Repetitive strain due to activities (recreational or work-related) requiring repetitive performance of movements. Sports requiring overhead motion, such as baseball, softball, tennis, volleyball or swimming can cause inflammation of the tendons and bursa in the shoulder.
- Overload strain, such as that which can occur during weight training or when lifting heavy objects, can strain a tendon or irritate the bursa, resulting in inflammation.
- Sudden injury or trauma, like falling on the shoulder.
- Postural factors that narrow the subacromial space, such as holding the head and shoulder forward, can irritate the shoulder tendons and bursa.
- A bony spur in the shoulder or anything that causes shoulder impingement can also lead to bursitis.
- Rotator cuff weakness that causes a muscular imbalance in the shoulder can lead to impingement of the tendons against the corocoacromial arch, which can cause inflammation of the bursa.
- Individuals with rheumatoid arthritis may be more susceptible to bursitis. Other contributing factors include gout, calcific bodies or an infection in the subacromial space.
Signs and Symptoms of Shoulder Bursitis
Symptoms of shoulder bursitis can vary in severity, but generally include:
- Pain in the front and upper portion of the shoulder. Pain is typically most noticeable during overhead movements or when sleeping on the affected side (the pain can make it difficult to sleep at night). Pain can be accompanied by a burning sensation during activity or passive movements of the shoulder. The most noticeable pain may occur within an 80 – 120 degree arc of motion.
- Feeling of tightness due to inflammation and swelling of the bursa. Swelling and redness can also be visibly seen in the shoulder area.
- Reduced mobility due to discomfort and tightness, which can be moderate to severe in nature. This can make it difficult to perform daily living activities, like getting dressed.
- If inflammation increases, weakness may be experienced in the shoulder.
Treating Shoulder Bursitis
Initial treatment following the onset of symptoms generally relies on resting the affected area and avoiding movements or activities that exacerbate the problem and increase pain. Additionally, the following treatments may improve the condition:
- Ice – To reduce inflammation and pain.
- NSAIDs (non-steroidal anti-inflammatory drugs) – To reduce inflammation and diminish pain, along with rest and avoidance of irritating activities.
- Steroid injections – If conservative treatment and avoidance of activity does not diminish symptoms, low doses of steroids injected into the area may further reduce inflammation.
- Physical therapy – Therapeutic and strengthening exercises, manual therapy, neuro-muscular reeducation, electrical stimulation, ultrasound and cold laser therapy are generally recommended if symptoms don’t subside. Pain medication may be given to reduce discomfort while individual performs necessary exercises.
- Surgery – In rare cases, surgery is required to correct an underlying pathology or bio-mechanical causes that result in shoulder bursitis (generally due to severe impingement or instability in the joint).
Managing Your Pain
Pain is a natural result of irritation and inflammation of the shoulder bursa. Treating the inflammation generally helps to alleviate pain. Some pain management techniques include:
- Rest and ice – Avoiding activities that exacerbate the irritation and icing the affected area can diminish inflammation, and subsequently any pain.
- Anti-inflammatory and other pain medications – NSAIDs and steroid injections work to reduce inflammation and pain. Additional pain medication may be required while an individual performs exercises during physical therapy and at home.
- Physical therapy – Exercises (therapeutic, stretching and strengthening), neuro-muscular re-education, manual therapy, electrical stimulation, ultrasound and cold laser therapy can diminish pain, reduce inflammation and improve mobility.
Most people experience a full recovery following treatment that may include a combination of conservative approaches, including medication, injections and physical therapy. Repetitive movement of the shoulder can cause the condition to recur, however. More severe cases of the condition resulting from significant impingement, such as from bone spurs, generally respond well to surgical decompression of the area. If a surrounding tendon tears or ruptures, surgical outcomes will vary depending on a number of factors.