A bursa is a fluid-filled sac that acts as a cushion to prevent structures like bones, ligaments and tendons from rubbing against each other. There are 160 bursae (plural of bursa) in the body, but the largest one is called the subacromial bursa, which is located in the shoulder. When this bursa becomes inflamed due to injury or any other reason, it results in a common condition called subacromial bursitis, or shoulder bursitis.
What causes shoulder bursitis?
The shoulder is a ball-and-socket joint in which the socket is the shoulder blade and the ball is the top part of the upper arm bone (humerus). Just above this joint is a piece of bone that sticks out called the acromion, and underneath the acromion is where the subacromial bursa is located. This bursa reduces friction between the acromion and a tendon in this region. As a result, we can safely perform overhead activities like throwing that require the use of the shoulder. In shoulder bursitis, something happens that causes the subacromial bursa to become inflamed, meaning the body is naturally reacting to some type of problem.
In most cases, this inflammation develops gradually over time from performing too many overhead activities on a regular basis. Any activities that involve raising the arm, repeated lifting, pushing or pulling increase the strain on the subacromial bursa and raise the risk for shoulder bursitis. Sports like baseball, swimming-especially the freestyle and butterfly strokes-golf and tennis, and even occupations like painting all require these motions. People who practice these activities often may therefore be at risk. For other patients, shoulder bursitis may result from a sudden injury like a fall on the shoulder or an outstretched hand. Additional risk factors include:
- Bad posture
- Having an unstable or weak shoulder
- Tightness of certain shoulder muscles
- Not properly recovering from a previous shoulder injury
***Note that the terms shoulder impingement syndrome and shoulder tendonitis are sometimes used when discussing shoulder bursitis. All conditions are related and may occur together, but they each describe a different problem with the shoulder.***
What are the symptoms?
The most common and noticeable symptom of shoulder bursitis is pain at the top, front and outside of the shoulder and upper arm. In addition:
- This pain usually gets worse while sleeping at night or when performing overhead activities or during lifting, pushing or pulling movements
- There may also be some redness or swelling around the shoulder
- Some patients notice a "crunching" or "popping" sound when moving the shoulder
- Muscles around the shoulder and arm tend to become weaker and less flexible as well, which can make it even more difficult to perform many day-to-day tasks
What is the treatment?
Occasional shoulder pain is fairly common for some athletes, but if you've been experiencing symptoms of shoulder bursitis for more a week or two, you should see a doctor or physical therapist. You will be asked some questions about previous injuries, your habits and when symptoms started, and a physical exam will be performed along with tests for your strength and mobility. Additional tests like an MRI, x-ray or ultrasound may also be needed to determine the root cause of the pain. Since there are many other problems that can lead to shoulder pain, it's best to rule these out in order to determine if shoulder bursitis is present.
Unless the condition is severe, most patients with shoulder bursitis will improve by following some conservative (non-surgical) treatments, and should recover within about 2-3 weeks. Some effective conservative treatments for shoulder bursitis include:
- Rest: take some time off from activities that make shoulder pain worse
- Ice: apply a cold pack to the shoulder for about 15-20 minutes, 3-4 times a day to alleviate pain and decrease swelling; the HyperIce Shoulder Ice Wrap allows you to ice your shoulder while still functioning normally
- Heat: using a heating pad can also help decrease pain and stiffness; apply for about 15-20 minutes, 3-4 times a day
- Sleep position: try to avoid lying on your injured shoulder and sleep on your stomach or back instead to reduce strain
In many cases, a course of physical therapy may also be needed to address your symptoms and help your shoulder improve. Each physical therapist will prescribe a different, customized program, but they typically include:
- Passive treatments: massage, mobilizations and manipulations are performed by the therapist on the patient's injured shoulder
- Stretching exercises: your therapist will determine which muscles are tight and assign active exercises performed by the patient to increase their flexibility
- Strengthening exercises: since muscle weakness is also a common problem, these active exercises-which often involve weights or stretch bands-will increase strength in and around the shoulder
- Education and activity modification: the therapist will educate you on what types of activities should be avoided altogether and which should be modified to avoid pain and other symptoms
- Braces: your physical therapist may also recommend using a brace to protect and stabilize the shoulder, and in some cases they may be worn when engaging in risky physical activities; the DonJoy Shoulder Stabilizer and Saunders DonJoy Sully Shoulder Brace are both ideal for this purpose
If conservative treatments aren't successful and symptoms continue or get worse, a corticosteroid injection may be recommended. This anti-inflammatory medication is injected directly into the shoulder and is meant to temporarily decrease pain and swelling.
In rare cases when patients still don't improve after following these recommendations, it may be necessary to consider surgery. Talk to your doctor about the risks of each surgical option, which include bursectomy (removal of the affected bursa), surgical drainage and tendon or muscle repair. A sling and rehabilitation will be needed afterwards if surgery is performed.
Can shoulder bursitis be prevented?
Since shoulder bursitis usually develops from moving the arm in a certain way too regularly, there are some changes you can make to reduce your chance of getting it. Here's how:
- Take frequent breaks while playing sports or activities that require overhead movements like baseball, tennis, golf and swimming
- Gradually increase the intensity of your exercise routine if you're involved in any of risky activities; a good rule of thumb is to increase by no more than 10% each week
- Always warm up and stretch-especially the shoulder-before sports and other physical activities
- Try to keep your shoulders strong and flexible at all times
- Wear warm upper-body clothing in cold weather