Blog post by Mark Tu (B.SC Physiotherapy)
What is shoulder bursitis?
Shoulder bursitis occurs when the bursa of the shoulder becomes inflamed. A bursa is a fluid-filled sac to lubricate and reduce friction around the shoulder. You have several bursae throughout the body that do the same in the body part they are located in. Bursitis usually occurs from a direct inflammatory process or more commonly, from an event causing sensitivity and irritation to the bursa.
Who can get shoulder bursitis?
Anyone is susceptible to shoulder bursitis. However, episodes are more common in those who participate in more overhead movements such as manual labourers, factory workers, and athletes. Other factors that lead to increased shoulder sensitivity and pain can be from overuse/repetitive movements, suboptimal movement patterns, trauma, infection, biological and inflammatory disorders.
What are the symptoms?
Most people will usually report localised pain and tenderness on the front and side of their shoulder. Symptoms may worsen with movements, particularly overhead and reaching movements. Overuse of the shoulder and repetitive movements can also irritate the bursa causing inflammation. In some cases, the shoulder may appear slightly swollen or warmer than usual. Your physiotherapist can assist you in correctly identifying the source of your symptoms and directing you to the most preferred intervention.
How can it be diagnosed?
Through obtaining a detailed history and performing an in-depth physical examination, your Physiotherapist will be able to diagnose the condition without requiring further imaging. Sometimes, you may be recommended to further investigate to rule our any other causes of your shoulder pain. An x-ray and ultrasound may be performed to rule out any pathology. In some cases, an MRI may also be used to further look at the shoulder in depth. Once the Physiotherapist has identified the causes of your bursitis, they will be able to treat your shoulder and assist with helping you manage it yourself.
Conservative treatment is usually the first line of treatment and most recommended. Treatment may include, movement retraining, soft tissue massage, taping, dry needling, and joint mobilisations to assist with reducing sensitivity of the shoulder. Home exercises are usually prescribed to maintain and further improve shoulder function. Evidence suggests steroid injections and surgery are unlikely necessary and only recommended if your symptoms become persistent. In theory, there are risks related to receiving more than a few steroid injections and there is limited evidence on the effectiveness of cortisone injections working alone as compared to engaging in an active exercise and rehabilitation program.
Subacromial bursitis is will usually resolve quickly with the correct treatment. Most people will improve well with conservative treatment with a few requiring further interventions to manage their symptoms. Even though there is a link with poorer outcomes associated with increased age, this condition is self-limiting and should not have a long-term effect on one’s quality of life. It is important to stay positive during the rehabilitation phase and to continue exercises for a period after symptoms improve to avoid further reoccurrence in the future.