What is Shoulder Bursitis? The Symptoms & Treatment Options

According to the University of New South Wales, approximately 1.7-2% of patients will complain of shoulder pain during a GP visit.[1] This extrapolates to over 500,000 Australians and could be an underestimation when factoring in people who do not seek medical support.

The leading cause of shoulder pain is a rotator cuff condition (e.g. shoulder tendonitis, tears) which leads to 65-70% of all cases.[1]

Read on to understand what you should know about shoulder bursitis; the risk factors, treatment options and expected recovery time.

What is Shoulder Bursitis?

Bursitis of the shoulder occurs when there is swelling and redness between the top of the arm bone and the tip of the shoulder. Between these bones lie tiny, fluid-filled sacs known as bursae, which help reduce friction between the bones in your joints.

What are the symptoms of shoulder bursitis?

The symptoms of shoulder bursitis include; shoulder tenderness, pain when lying on the affected shoulder, and pain with movement (particularly anything overhead).[2] People may also experience sharp or pinching pain with movement.

Common symptoms of shoulder bursitis

• Pain on the outside or top part of your shoulder

• Swelling and redness around the shoulder area

• Pain when lying on the side of your shoulder

• Right shoulder and arm pain

• Decreased shoulder range of motion

• Difficulty raising your arm above your head.

What causes shoulder bursitis?

Bursitis of the shoulder is most commonly caused by injury or overuse, typically with overhead activities. People may also experience shoulder bursitis due to infection, gout or tendonitis.

Common causes of shoulder bursitis

• Lifting overhead repeatedly

• Resulting from a fall

• Heavy manual labour

• Leaning on your elbows

• Scrubbing the floor

Some work may require you to use your shoulder and arms excessively, which adds risk for having shoulder bursitis.

• Assembly-line work

• Gardening

• Carpenters

• Athletes

• Musicians

Common conditions that cause shoulder bursitis

Various medical conditions can irritate the shoulder bursa. If you have one of these conditions, you also have a higher risk for shoulder bursitis:

• Gout

• Rheumatoid Arthritis

• Diabetes.

Sports that increase the risk of shoulder bursitis

Sports can cause a high amount of stress or impact on your shoulder joint, which may increase the chance of irritation in the bursa resulting in shoulder bursitis:

• Basketball

• Tennis

• Competitive weight lifting

• Baseball or Softball

• Javelin

There are many causes of shoulder bursitis that need to be considered. Understanding what activities that you may be participating in that can increase your shoulder pain is helpful in accurately diagnosing your injury.

How is shoulder bursitis diagnosed?

Shoulder bursitis can be stressful and cause a lot of pain that could limit your movements. People with this injury tend to limit the use of their shoulders for long periods, which causes further complications.

There are several options available when it comes to diagnosing your shoulder pain as bursitis. One of the most common and most recommended by Australian GPs is an assessment from a physiotherapist.

Physiotherapists are experts in the field of joint rehabilitation and pain management. They can effectively diagnose and treat musculoskeletal conditions and joint issues such as shoulder bursitis.

An assessment from a physiotherapist is comprehensive and straightforward. The first part of your assessment with your physiotherapist would be similar to visiting a GP. You will be asked questions regarding your health and lifestyle. It is best if you take this time to discuss relevant issues about your shoulder injury.

After establishing the background of your condition, your physiotherapist will then perform a physical assessment to determine the exact cause of your symptoms and rule out other conditions.

Your physiotherapist will then create a diagnosis and treatment plan based on your assessment. This whole process will take about 30 to 60 minutes.

You will also be given the details of your program. This will include:

• Number of treatment sessions

• List of exercises you need to do at home

• Strategies to manage the pain and prevent complications

• Timeline of your recovery.

How is shoulder bursitis treated?

Shoulder bursitis can last for a long time. It causes severe pain and discomfort, which may result in limitations in your daily activity. Persisting pain and inflammation on the shoulder bursa should not be ignored.

There are several options when it comes to treating shoulder bursitis. One of the more common options referred to by Australian GPs (your local doctor) is physiotherapy.

Rest and medication may provide some relief, but specific issues in your shoulder joint that can complicate your condition, such as muscle weakness, poor joint mechanics, and postural imbalance, can only be addressed by rehabilitation.

Physiotherapists see patients suffering from shoulder bursitis regularly, and the process of treatment is relatively straightforward. After your initial consultation, the physiotherapist will have a better understanding of your shoulder pain and can put together a treatment plan specific to your needs.

Physiotherapists are experts in treating pain and musculoskeletal issues of the shoulder joint, and they can help you decrease your pain and improve your overall condition.

Your treatment will focus on controlling the pain and decreasing the swelling of the shoulder bursa. Your physiotherapist will also address specific issues around the shoulder region to ensure a complete treatment approach to your recovery.

Depending on the severity of your shoulder pain, a physiotherapist may provide you with a combination of the following types of treatments:

• Manual therapy - Hands-on treatment that reduces your pain and improves the overall mobility of your shoulder.

• Therapeutic exercises - Exercises used to correct impairments and restore proper functions of your muscles, tendons and joints.

• Stretching - Movements used to improve your range of motion, decrease muscle tension and pain.

• Joint mobilisation - These are techniques that your physio will use to apply rhythmic or sustained pressure on your joint to increase range of motion and reduce pain.

• Soft tissue massage - Manual techniques that promote relaxation of the muscles to naturally decrease muscle spasms and pain.

• Ultrasound therapy - Ultrasound uses ultrasound waves to penetrate deeper structures of your body and cause deep tissue heating effects, promoting increased blood circulation around the area and promoting faster healing.

Next step - Creating a treatment plan made for you

Following your first visit, your physio will create a detailed treatment plan based on your goals and lifestyle to ensure that you get the most out of your recovery and get back to doing the things that you love to do.

Self-care for shoulder bursitis

If you have shoulder bursitis, here are the best things you can do and avoid.

Things to do:

• Rest

Take a break from your daily activities. Sleep and drink a lot of water to support your body’s healing process.

• Apply cold compress

Use a cold compress on the affected shoulder to manage the swelling and reduce pain. Apply for 10 to 15 minutes every 2 hours until pain decreases or the swelling subsides.

• Wear a shoulder brace

Wearing a shoulder brace can be a good reminder for you not to use your affected shoulder in the meantime. This will allow sufficient rest for a couple of days.

Things to avoid:

• Avoid activities that worsen the pain

Avoid activities that put your shoulder in a compromising position, such as prolonged use of computers, scrubbing the floor or extensive overhead activities.

Do I need a specialist or surgery?

Severe shoulder bursitis may need a steroid injection to manage the pain and swelling.

Blood tests may be done to rule out systemic conditions if you have a fever or other symptoms. Shoulder bursitis with persistent swelling and fever are indications of infection and may need medication.

Diagnostic imaging such as an X-ray or MRI can be done to identify shoulder bursitis and screen for calcifications.

Your GP will coordinate with your physiotherapist if they determine that your condition can be treated conservatively.

What is the recovery time / prognosis for shoulder bursitis?

Ultimately, recovery time is dependent on your proactiveness to seek professional treatment and the severity of your shoulder pain and injury.

In some cases, patients begin to feel the benefits of manual therapy in just one session. Typically, full recovery for shoulder bursitis can be between 2-6 weeks, while the more severe cases can take 6-12 weeks.

Important factors in recovery include:

• Sticking to your specific rehabilitation program and exercising regularly

• Resuming your sports activity gradually

• Paying attention to pain, and resting as necessary.

Can shoulder pain be prevented?

Guaranteeing prevention can be impossible; however, you can decrease the risk of shoulder bursitis through some of these techniques:

• Ice for cooldown - If you are engaging in high-intensity activities involving the shoulders, such as tennis, you should use a cold compress to decrease inflammation in the shoulder region.

• Take frequent breaks - Phase your activities and take sufficient rest in between repetitive tasks involving the shoulder.

• Warm-up - Always warm up before engaging in high impact activities. Shoulder bursitis often gets irritated following shoulder injuries such as rotator cuff tears.

• Practice good posture - Your posture plays a huge role in the mechanics of your body. A bad posture can increase the stress on the shoulder when doing an activity. Keep your shoulder rotated down and back when using a computer.

Outlook and the main takeaways

The main takeaway from this article is that whilst shoulder bursitis is painful and can be quite distressing there is something you can do about it. Pain is just a signal reminding you to take action! Book a time with a physiotherapist today and start feeling better soon.

Anatomy of the shoulder bursa

The shoulder has six bursae that serve as a cushion to prevent friction and excessive stress between the bones, tendons and muscles.

• Subscapular bursa or scapulothoracic bursa - found between the tendon of the subscapularis and the joint capsule.

• Subdeltoid bursa - located between the deltoid muscle and the shoulder cavity.

• Subacromial bursa - located just between the acromion process and above the greater tubercle.

• Subcoracoid bursa - situated between the coracoid process and shoulder joint capsule.

• Infraspinatus bursa - between the infraspinatus tendon and the capsule

• Subcutaneous acromial bursa - located between the acromion and the skin.