What is Shoulder Bursitis?
Shoulder Bursitis is one of the more common causes of shoulder pain. An estimated 65% of people will experience shoulder pain at some point in their lives. One common cause of shoulder pain is called shoulder bursitis. So, what is it? The short answer is within the shoulder joint we each have a small sac-like cushion protecting the tendons. This fluid-filled sac is called the bursa. When the sac becomes chronically inflamed or irritated, it is called bursitis.
To understand how this happens, we must first understand the shoulder joint. The shoulder joint is made up of 3 primary bones, the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The unique shape of the humeral head, ball-shaped, fits neatly into the scapula bone giving its nickname as a ball and socket joint. One of the main jobs of the scapula is that it attaches the arm to the body.
The clavicle bone connects to the acromion (a bony projection of the shoulder blade) forming another joint within the shoulder region. The main job of this joint, also known as the acromioclavicular joint, is to allow for the arm to lift overhead as well as to rotate.
In addition to the complexity of the structure of shoulder, it is also a compact, meaning, the space within the joint is narrow and tight. In this narrow space muscles, tendons, ligaments, and the bursa sac come together. Each is interdependent of one another; therefore, when one soft tissue structure is irritated or injured the surrounding soft tissue will also typically breakdown as well.
Bursitis typically starts as general shoulder pain due to repetitive overhead or rotation of the arm. Over time the shoulder becomes irritated causing the bursa sac and surrounding soft tissue become inflamed which leads to a thickening of the tissue. Over time if not treated properly, this thickening causes a decline, or altogether avoidance, of daily activities because symptoms worsen.
What causes shoulder bursitis?
Shoulder bursitis happens at any age, but more commonly it occurs in the middle-aged and elderly. The most common causes of bursitis include muscle weakness and imbalance, repetitive overhead activities, and frequent twisting or rotation of the arm. The shoulder is compact joint; it is vulnerable to overuse, irritation, and inflammation.
In addition to the middle-aged and elderly being susceptible to bursitis, it also commonly occurs with athletes, especially overhead athletes like baseball players, volleyball players, and swimmers. The repetitive motion and friction during these activities can eventually irritate the shoulder causing shoulder pain, and if not taken care of, it can lead to shoulder bursitis or impingement.
The few most common causes of shoulder bursitis are:
- Repetitive overhead activities
- Muscle weakness and imbalance
- Trauma (falling on the shoulder, being hit, etc.)
- Bone spurs
- Poor posture
Symptoms of Shoulder Bursitis
Simply put, the shoulder hurts with movement. Typically, bursitis pain occurs over a period of weeks to months. Shoulder pain may worsen during activities, especially with overhead or rotational movements of the arm. Sleeping also becomes impacted. Bursitis pain is commonly felt in the upper part and towards the outside of the shoulder and often described as “pinching” pain. It can be tender to touch too.
Monitor, the onset of shoulder pain, closely. If it goes on too long and is not taken care of through proper treatment, a simple shoulder pain condition can quickly turn into a more complex condition such as shoulder bursitis or impingement.
How is shoulder bursitis diagnosed?
A PT (physical therapist) can provide a conservative diagnosis. With a thorough examination, a PT can often determine the primary cause of shoulder pain. This is done with conducting a review of your medical history, performing special tests to rule in, or out, the cause of your symptoms and he or she will ask specific questions related to your symptoms including:
- When was the onset of your symptoms?
- What activities make the pain worse?
- Where is your exact point of pain?
- Was there any trauma to the shoulder? If so, what was it?
- Was the onset of your symptoms gradual or immediate?
- Do you perform repetitive activities?
If you seek medical care from a physician, they too will go through a medical history and examine the shoulder. Quite often, they will order an image like an X-Ray or MRI (magnetic resonance imaging) to look internally at the shoulder structure.
An X-Ray will provide a view of the bone structures to rule out any fractures, bone spurs, and malalignment of the joint. An MRI will look closer at the shoulder structure along with images of the tissue to provide information about swelling, in addition to or only damage to the tissue, like a tear.
Treatment of Shoulder Bursitis
The main goal is to reduce swelling which in turn will reduce symptoms. Within the first 24-48 hours of onset, minimizing exposure to activities that cause symptoms to worsen is key. In some cases, ice and over-the-counter anti-inflammatory medications may help manage symptoms. If symptoms persist or worsen, seeking out medical advice is recommended. The longer you wait, the more likely tissue becomes inflamed, irritated, and then begins to thicken, which means simple shoulder pain may turn into a more complex shoulder condition like bursitis.
Physical therapy is the key to getting the cause and managing symptoms. Too often, only pain management is addressed, which causes a reoccurrence of shoulder symptoms. Seeking care from a physical therapist will not only help you manage your pain but more importantly, your therapist will provide you with how to manage this condition for the long-term. Getting to the primary cause and fixing it is key to avoid cyclically or worsening of symptoms.
Physical therapy will customize goals to fit your needs and condition. No matter the condition or state of your shoulder, a physical therapist will work to do the following:
- Reduce swelling
- Improve motion
- Gain shoulder strength and endurance
- Educate on proper movement and posture
- Return to activities.
Getting you back to doing the things you love to do is your PT’s primary goal. He or she will help you return to function and teach you how to avoid the condition from returning.
In some cases, chronic shoulder bursitis conditions may need more than just physical therapy. In some rare cases, a patient may need an anti-inflammatory injection. Sometimes the thickening of the tissue has gotten so bad, that conservative treatment alone will not help. If you do need an injection, physical therapy is still very important. Remember the injection only manages the symptoms, but is does not address the cause.
In the most severe cases, a patient may require surgery. This specific surgery is called subacromial decompression. In this case, a surgeon makes a small incision, and they remove the bursa sac along with any possible bone spurs, freeing up space within the joint, therefore, alleviating the pressure of the rotator cuff and surrounding tissue.
If you are a candidate for surgery, recovery can vary depending how much damage there is within the shoulder joint. Typically, the initial healing will take anywhere from a few weeks to possibly a few months. You are recommended to go to physical therapy after surgery. During physical therapy, you will receive swelling management and receive help safely regaining movement and strength.
Seek out medical attention if your shoulder pain is persistent, worsens, or is impacting daily activities such as work, hobbies, or sleep. Contact your medical provider whether it is your physical therapist or your physician, he or she will establish a plan for conservative care and only in extreme cases may surgery be needed.
As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.
Most states have direct access to a physical therapist, meaning you can go directly to a physical therapist without a physician order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
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