Shoulder Bursitis

What is it?

Shoulder bursitis is a painful swelling and inflammation of a bursa located in the shoulder.

Bursae (plural of bursa) are thin, fluid-filled pouches that function as a ‘cushion’ between bone and soft tissue structures such as ligaments, tendons, skin or muscle. The fluid in the bursae is known as synovial fluid, which provides lubrication to reduce friction between structures.

Bursae are located all around the body, particularly around the joints, and play an important role in facilitating pain-free movement.

Bursitis refers to an enlargement of the bursa. When bursitis occurs, the bursa becomes inflamed with an excess of synovial fluid. The now enlarged bursa can be compressed against the bone or soft tissue structures, and any movement that causes friction on the bursa can produce pain.

The shoulder has various bursae highlighted above, with Subacromial Bursitis being the most common form of bursitis.

 

Symptoms

  • Pain with overhead movements of the shoulder (most common past 90 degrees)
  • Dull pain around the front and outside and tip of the shoulder
  • Tenderness over the area
  • Swelling / redness that may be warm to the touch
  • Reduced range of motion (ROM) of the shoulder

 

What causes it?

Bursitis is a secondary symptom caused by many factors. Bursitis can be aseptic or septic: if bursitis is caused by bacterial infection, then it is classified as septic.

Shoulder bursitis is most commonly caused by:

  • Excessive local friction / overuse: e.g. in Subacromial Bursitis, repetitive overhead movements such as hanging out the washing, painting or heavy lifting can place strain on the bursa
  • Thoracic spine stiffness or forward (rounded shoulder) posture (read our article on this)
  • Underlying weakness or dysfunction of the scapular stabilising muscles (Serratus Anterior, Traps and the Levator Scapula) and / or the rotator cuff muscles (Supraspinatus, Infraspinatus, Teres minor and Subscapularis)

Other factors:

  • Shoulder impingement / rotator cuff tendinopathy
  • Rheumatoid arthritis
  • Long periods of increased pressure over the area: such as carrying a backpack for a long period of time
  • Direct trauma

Diagnosis

Your Physiotherapist will perform a series of special tests to determine the presence of shoulder bursitis.

An MRI or X-ray may be recommended to confirm the diagnosis of bursitis or to identify other pathologies, as shoulder bursitis often coexists with shoulder impingement.

MRI of the Subacromial/Subdeltoid Bursae

Physiotherapy management

The main goals of our rehabilitation are to:

  1. Manage and eliminate symptoms
  2. Provide postural education and training
  3. Regain range of motion
  4. Regain and maintain strength

A recent study published to the American Orthopaedic Society of Sports Medicine, found that for the best outcomes of pain, range and strength in shoulder bursitis (particularly Scapulo-thoracic) included a rehabilitation program that was comprehensive and multifactorial, focusing on:

  • Scapular strengthening
  • Postural re-education and training
  • Core strength endurance

Various treatment modalities can be adopted by your Physiotherapist to best suit your needs. Depending on the severity of bursitis, your doctor may also recommend corticosteroid injection into the area to relieve inflammation and pain.

Below is a list of forms of treatment that best address the symptoms of shoulder bursitis.

Initial/acute phase

  1. Appropriate RICE regime to decrease pain and inflammation
  2. Active assisted range of motion (AAROM) exercises to keep the joint moving

Post-acute phase

  1. Soft tissue/deep tissue massage
    • Manual tissue massage to muscles surrounding the bursa improves blood flow and decreases tension and stiffness of the shoulder joint
  1. Shoulder glides and mobilisations
    • Physiotherapists can apply manual techniques that increase ROM at the shoulder
  1. Scapulo-humeral rhythm and postural training
    • Restores and maintains synergistic movement at the shoulder which improves shoulder function
    • Postural training is vital in opening Subacromial space. Training is focused primarily on correct scapular positioning
  1. Scapular, thoracic and core strengthening
    • Muscular strengthening improves overall shoulder function and reduces the risk of re-injury
  1. Shoulder stretching program
    • Shoulder stretches improve ROM at the shoulder joint, there are a plethora of shoulder stretches than can be integrated into your program
  1. Taping
    • De-loading the bursa through taping inhibits pain-free movement of the joint through range
  1. Ultrasound
    • Decreases overall inflammation of the shoulder joint

 

In summary, shoulder bursitis is a condition which can detrimentally affect daily living. It is paramount to take care of our shoulders and to recognise the importance of our bursae in producing pain-free movement.

Check out our 3-part program on easy and effective scapular positioning and strengthening exercises performed with a thera-band:

Part 1 – Scapular mobility for shoulder posture

Part 2 – Scapular retraction exercise to improve posture and back strength

Part 3 – Shoulder strengthening exercise for improved functional movement

If you have any further questions or want to book an appointment, don’t hesitate and get in touch!