Shoulder Bursitis
Contents
What is Shoulder Bursitis?
Bursitis of the shoulder occurs when one of the bursae sacs in your shoulder becomes inflamed. A bursa sac is a capsule filled with synovial fluid which acts as a cushion between the bones in the shoulder to prevent bone on bone pain. There are several bursae sacs in a shoulder, although the subacromial sac is the one that is most likely to become inflamed and thus painful.
Subacromial bursitis is the most common form of shoulder bursitis. The subacromial bursa is located under the acromioclavicular joint in your shoulder (the bony part that sticks out in your shoulder). Subacromial bursitis also commonly occurs with shoulder impingement.
What Causes Shoulder Bursitis?
Shoulder bursitis can be caused in many ways, the most common being repeated minor trauma. This typically occurs with overuse of the shoulder muscles and joint, which is referred to as acute shoulder bursitis. People who carry out physically demanding jobs such as labourers, athletes, and musicians, are at higher risk of developing bursitis.
In more severe cases, severe trauma from a car crash or fall can put significant stress on the shoulder joint and bursa, resulting in chronic shoulder bursitis.
Medical conditions such as rheumatoid arthritis, diabetes, and gout can also cause inflammation in the bursa.
What Causes Pain in Shoulder Bursitis?
When the bursa is injured, there is inflammation and the bursa becomes thickened. This results in a reduction in the subacromial space (the space underneath the shoulder tip). Due to this restriction in space, there is more friction on the bursa which leads to pain.
Symptoms of Shoulder Bursitis
People suffering from shoulder bursitis typically experience localised pain at the top of their shoulder tip (the bony part), swelling and/or tenderness when moving the shoulder.
Tenderness of the inflamed shoulder joint will occur with bursitis, as well as a pinching pain or impingement when moving the arm. The most agitating movement or position is with anything overhead (ie. Moving your arm above 90 degrees or above your head)
How do you Diagnose Shoulder Bursitis?
Bursitis is diagnosed in several ways, the most common being through physical examination. In more severe cases, imaging may be required: Magnetic Resonance Images (M.R.I.), or ultrasound.
Recovery Time for Shoulder Bursitis
Shoulder bursitis is by no means a permanent injury and it is quite possible to recover from it. Unfortunately, exercise and manual labouring jobs exacerbate this injury and thus the possibility of a flare-up later is highly likely.
The recovery time depends heavily on how severe the injury is, when the patient begins treatment, and whether or not the patient completes their prescribed exercises. There is no definitive recovery time but it typically ranges from 4 weeks to 6 months.
When the bursitis is the result of a physical injury, the recovery is simpler and can be treated within a few days to weeks. This is because the inflammation in the bursa sac is relatively recent and therefore there are less complications and easier to treat.
When the bursitis is caused by overuse, the recovery time can be longer, lasting up to several months. This is because the problem has developed over a longer period of time and the bursa sac has slowly become more thickened over time.
In rare instances, bursitis can be chronic and unable to heal when caused by medical issues, particularly rheumatoid arthritis. In these cases, the pain caused by the bursitis would need to be managed by conservative treatment, cortisone injections, anti-inflammatory medication, and exercises.
Exercises for Shoulder Bursitis
There are certain exercises that can assist in speeding up recovery and strengthening a shoulder with bursitis. Completing exercises daily can activate the muscles in the shoulder without putting too much stress on the bursa sac. A sports chiropractor can give you a routine exercise plan to help with this.
Shoulder rotation: stand upright and raise the shoulders to the ears and hold, squeeze the shoulder blades together behind the back and hold, pull the shoulder blades downward and hold. Repeat.
Door presses: stand against a doorway, bend the elbow of the injured arm, press the back of the hand to the doorframe. Repeat.
Stick lifts: using a stick or broom stand up right and hold it in both hands with palms facing down, slowly raise the stick overhead while arms are straight, hold and then slowly lower. Repeat.
Does Swimming Help Shoulder Bursitis?
Continuing to swim when the shoulder bursa is severely inflamed will continue to put it under stress. However, with mild bursitis, or partially treated bursitis, continuing to swim with modifications of a swimming program while undergoing treatment is ok and can slowly increase the durability of your shoulder.
Does Yoga Help Shoulder Bursitis?
Yoga for bursitis is aimed to improve the strength, movement and mobility of the shoulder. The multiple postures involve hand gestures called Hasta Mudra which focus on raising the arms, interlocking fingers, pressing palms together, and holding them behind the back.
This helps ease and alleviate pain in the shoulders by bringing more awareness of the muscles and engaging them to take stress off the bursa sac. Gradually starting under the guidance of a yoga teacher to practice static postures can aid in properly learning how to engage and strengthen the shoulder muscles to bring more stability back.
Treatment for Shoulder Bursitis
Sports chiropractors play an important role in treating and preventing bursitis. Sports chiropractors typically have more experience in these injuries as it is a common injury in the athletic population.
The treatment plan typically consists of hands-on modalities to assist with reducing inflammation in the joint. This is then paired with a plan of exercises to help improve pain and assist on strengthening tendons while reducing swelling in the bursa sac.
Sports chiropractors can also administer electrotherapy modalities to speed up the healing time. For shoulder bursitis, we do not typically recommend a brace or sling but taping with either rigid tape or kinesiotape (Rocktape) can provide extra support and take pressure off the affected shoulder.
When treating bursitis, it’s important to remember that it is an inflammation of the bursa sac. Anti-inflammatories are typically the go-to treatment prescribed by medical practitioners. However, taking non-steroidal anti-inflammatory drugs (NSAIDs) will have a negative impact on how the body naturally copes with inflammation. Aspirin and ibuprofen can reduce swelling and discomfort in the shoulder and are available over-the-counter.
It is best to avoid any strenuous activities that requires excessive shoulder movement as this will give the bursa sac time to relax and become less irritated. Nonetheless, it is still important to continue to move the shoulder in light exercises to ensure that the joint doesn’t become stiff.
In severe cases, a cortisone injection may be recommended. Typically this is not the first option as there are long term consequences to cortisone injections. Nonetheless, in severe cases, this may be necessary and you would need to speak with a medical practitioner regarding this option.
At-Home Treatment for Shoulder Bursitis
Although there are no ways to self-treat bursitis, there are some ways to help manage the pain and strengthen the rotator cuff muscles that doesn’t require seeing a healthcare professional.
Applying heat to the affected area can reduce stiffness by stimulating your sensory receptors and increasing elasticity in your muscles.
Stretching the shoulder muscles, tendons and ligaments can improve the durability of the bursa sac and help reduce swelling. This is done via lengthening the muscles and tendons around the shoulder as to not hold the joint against the bursa sac too firmly, thus irritating it. Stretching before and after exercise helps the muscles warm up and cool down so they don’t spasm and build up with lactic acid.
Surgery for Shoulder Bursitis
Surgery for bursitis of the shoulder is only considered when the bursitis has persisted for 6-12 months and is not responding to any other forms of therapy. It is recommended that all other path ways are taken first before resorting to the final option of surgery.
The surgery can repair damage and reduce the pressure on the bursa sac. It is done via a small incision with a particular probe called an arthroscope to be as minimally invasive as possible. The inflamed bursa, some of the joint’s bones and any bone spur growths are removed to create a larger cavity for the synovial joint, and rotator cuff tendons.
Cortisone Injection for Shoulder Bursitis
The second last option that is suggested is cortisone or steroid injections into the inflamed bursa sac. It is important to note that the injection assists with reducing swelling in the joint and may not alleviate all the pain.
Pain from shoulder bursitis is largely due to swelling of the bursa sac and the body’s neural system letting the brain know that there is an issue occurring within the joint. To help alleviate the pain as well as the swelling, some injections are a combination of corticosteroid and local anaesthetic into the bursa.
Specific preparation for a bursal injection is not necessary. Any x-rays, ultrasounds, MRI’s or CT scans should be taken to your appointment.
In some instances, the practitioner may recommend an ultrasound-guided injection. In this case, the injection site is imaged with an ultrasound machine to guide the needle. After an injection, some patients do express a worsening of symptoms over the first 1-3 days.
Unfortunately, cortisone injections are not permanent and typically only last about 6 weeks. Multiple injections are not recommended as this can lead to weakening of the shoulder tendons.