Shoulder Bursitis And Shoulder Impingement

What Is Shoulder Bursitis?

Shoulder bursitis is a condition where there is an inflamed bursa in the shoulder. A bursa is a fluid filled sac that helps to reduce friction in your shoulder spaces and occur throughout the body not just exclusively in the shoulder. The Subacromial bursa is the most commonly inflamed bursa of the shoulder and is termed subacromial bursitis when this fluid sac is inflamed and symptomatic. For the purpose of this blog when referring to bursitis, I will be referencing the subacromial bursa as the source of symptoms, or focus of treatment.  In my Sydney physio practice bursitis in the shoulder is a common reason people seek my assistance, the cause of this shoulder pain relating to subacromial bursitis is usually triggered by the impingement of the bursa between your rotator cuff tendons, their insertions and the acromion (the part of your shoulder blade that forms the roof to the shoulder joint).

Signs And Symptoms Of Shoulder Bursitis?

Bursitis and subacromial impingement will commonly present with the following symptoms:

• Although pain with shoulder bursitis can come on quickly following a fall, or some other traumatic event, shoulder bursitis at least in my experience is generally more likely to have a gradual onset, with symptoms developing over weeks, even months.
• Pain associated with bursitis is typically experienced on the outside of your shoulder (deltoid region), and regularly can spread down the upper arm towards the elbow, even the wrist.
• Pain is often aggravated when lying on your affected shoulder and in my experience, sleeping position is a significant trigger/aggravating factor associated with shoulder brusa pain and if not addressed, many people will fail to progress at a satisfactory rate.
• Pain is worsened when using your arms above shoulder/head height. With arms by your side there is generally minimal pain, because when your arm is at your side the bursa is not normally impinged (unless it is grossly inflamed). Shoulder pain with simple every day activities such as washing your hair, or reaching up to get something off a high shelf is very common because when you elevate your arm further out to the side or forward the bursa rolls beneath the bone creating an impingement situation causing pain.
• The presence of a “painful arc” of movement, a painful arc is where shoulder pain is felt between 60 – 90° of movement of the arm going up and outwards from the side or the body. This arc of pain occurs because when your arm is at your side the bursa protrudes laterally and is not normally impinged. However when you elevate your arm out to the side moving up to shoulder height and then above head height, the bursa rolls beneath the bone causing impingement and then as you continue to elevate your arm the bursa eventually rolls clears of the “impingement zone” and your the pain eases creating the arc of pain. However, in may individuals further impingement of the bursa and hence pain may return, at the extreme of range when your arm is up next to your ear in full elevation.

Diagnosing Bursal Issues Of The Shoulder?

Shoulder bursitis commonly co-exists with other shoulder pathology and is frequently associated with rotator cuff tendinopathy. Your physiotherapist will use special tests to help diagnose and differentiate if necessary between shoulder bursitis and rotator cuff injury, or other possible causes of shoulder pain. The use of X rays, ultrasound imaging or an MRI can be useful to help confirm the diagnosis, or better plan the treatment approach when findings are unclear with normal history and assessment or if response to treatment is slow.

What Are The Potential Causes?

Shoulder bursitis can be caused following a significant trauma such as a fall, but is more commonly caused from repeated minor trauma, such as overuse of the shoulder joint. This repetitive trauma is common in sports such as tennis, throwing sports, or weight lifting, but also common from repetitive everyday day activities like hanging washing, or occupations like electricians, painters, gardeners, or cleaners.

Can You Prevent Bursitis In The Shoulder?

As with many conditions, “a pinch of prevention is worth a pound of cure” so working to eliminate potential causes of shoulder impingement and bursitis in the first instance is always better option than trying to fix shoulder bursitis once you already have the pain. Factors such as thoracic and scapula posture, soft tissue mobility of the shoulder capsule, surround muscles and rotator cuff strength are things that can be addressed and optimized via the use of specific exercises, helping prevent the onset of shoulder bursitis. A physiotherapist is trained in identifying potential risk factors relevant to your individual situation and setting up an action plan for you to work to address such factors either independently, or under their guidance.

Physiotherapy Treatment For Shoulder Bursitis?

Shoulder bursitis is common and unfortunately it is often an injury that takes considerable time to settle completely. The pain can also often come back if you return to sport, work, or any aggravating activities too quickly. I would like to think that as a physiotherapist I can help you avoid one of these relapses of pain and accelerate the recovery time frames.

• Your rotator cuff is an important group muscles of the shoulder that work to maintain the ball of the shoulder joint centered in the small socket, helping prevent injuries such as bursitis and impingement.
• Your shoulder blade (the “scapular”) has a vital role. The scapula is ideally the dynamically stable base plate that attaches your upper limb to your chest wall. A “sick” scapula that either isn’t moving or positioned correctly can be a significant causative factor in impingement issues of the shoulder.

Correct firing and movement of the rotator cuff and the shoulder blade respectively are crucial to the normal functioning of your shoulder. Treatment of shoulder bursitis will frequently focus on improvement of any issues noted with the rotator cuff, or scapular. In persistent, severe, or acute traumatic shoulder bursitis a corticosteroid injection to help reduce inflammation may be used to good effect (however, results can vary considerably). Even in stubborn conditions that ultimately end up going down the cortisone path physiotherapy is still commonly used in conjunction with these injections, focusing on addressing any predisposing factors recognized during assessment, to reduce the likelihood of the complaint returning.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding Shoulder Bursitis And Impingement should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist or physiotherapist.