Bursitis is one of the leading causes of shoulder pain. It can lead to lost workdays and, in some cases, even disability. (1) So, what is bursitis of the shoulder?
In simple terms, bursitis happens when you have a swollen bursa. With shoulder bursitis, the inflammation compromises the bursa’s lubricating properties. Thus, leading to painful movement.
And, since the shoulders are among the body’s most used joints, the injury can feel very irritating.
Here are more things about shoulder bursitis that we will be covering:
- Signs and symptoms
- Types of shoulder bursitis
- Risk factors
- Prevention tips
Let’s get to it!
What does having bursitis feel like
Signs and symptoms of shoulder bursitis include:
- Shoulder pain after a recent increase in activity
- Sharp pain after activity
- Shoulder pain when lying at the affected side
- Shoulder pain with fever and chills
- Pain with overhead motion such as brushing your hair
- Night pain
- Shoulder stiffness in the morning
- Shoulder swelling and redness
Types of shoulder bursitis
The classifications of shoulder bursitis depend on its causes.
1. Traumatic bursitis
This is a type of shoulder bursitis that may come after a violent, direct hit to the joint.
- Getting tackled on the shoulder
- Falling directly on your side
- Falling on an outstretched hand
2. Chronic bursitis
This type of bursitis is secondary to overuse or other conditions. These cause constant rubbing or pinching of the bursa. This, in turn, leads to frequent bouts of pain and swelling.
3. Septic bursitis
This can come from a puncture, open wound, cut, or insect bite. Septic bursitis could also happen because of systemic disease. For example, rheumatoid arthritis.
When bacteria go inside the body, they can infect the fluid within the bursa. Aside from shoulder pain and swelling, signs of infection such as fever and chills may be present as well. (2)
Who is at risk for shoulder bursitis?
Risk factors for developing shoulder bursitis include the following:
- Being above 50 years old
- Engaging in repetitive/overhead arm motions
- Having poor posture
- A hook-shaped shoulder blade
- Systemic diseases such as rheumatoid arthritis, diabetes
How is shoulder bursitis diagnosed?
Diagnosing shoulder bursitis entails 3 things:
- Your recent history,
- A physical exam, and
- Diagnostic tests
Having said that, your doctor or therapist will ask about your recent activities. They do this to look for instances that may explain your bursitis symptoms.
Also, they might ask about your age and medical history.
Simultaneously, the medical professional assigned to you will also do a physical examination. He/she will check:
- Your posture,
- Your shoulder, and
- Palpate areas that might be showing signs of swelling, redness, and/or tenderness.
Finally, he/she might order X-rays, ultrasounds, MRIs, and/or blood and fluid tests. These are tests that confirm or rule out the diagnosis, as well as check for possible infection.
Treatment options for shoulder bursitis
Shoulder bursitis does well with non-operative management. But, there are also times where surgery is necessary. Let’s start with some of your less invasive options:
Conservative treatment options
Pain medications like non-steroidal anti-inflammatory drugs (NSAIDs) help manage pain and swelling. These work for both traumatic and chronic bursitis.
Frequently used examples include naproxen, celecoxib, and mefenamic acid.
But, for septic bursitis, a course of antibiotics is usually prescribed. This is to deal with the infection and prevent it from spreading.
Bursal aspiration with corticosteroid injection
Bursal aspiration uses a needle and a syringe to remove excess fluid from the swollen bursa. Corticosteroids offer effective pain relief.
Evidence shows that this combination can reduce shoulder pain for several months.
They’re used when other types of non-operative management become ineffective. (3)
Depending on your symptoms, you can undergo a couple of weeks to a few months of physical therapy.
Your physical therapist can use different methods to treat your shoulder bursitis. Different methods also improve different aspects of your health, including:
- Pain and swelling relief using cryotherapy, shockwave therapy, Kinesio taping, and other modalities.
- Improving your strength with a tailored strengthening program. The focus here will be on your shoulder stabilizers and trunk muscles.
- Enhancing your range of motion using different techniques. These include stretching, joint mobilization, and cupping.
- Boosting your recovery time. Physical therapists help you maximize your body’s healing potential. They can help you get better regardless if you choose conservative treatments or the surgical route.
When is surgery indicated?
Surgery is indicated if you still have shoulder pain even after undergoing therapy.
Full recovery can happen after a few months. Though, the exact time frame also depends on the type of surgical procedure.
Some of the surgeries that treat bursitis include:
- Bursectomy – This is the surgical removal of the entire inflamed bursa. The surgical site usually heals after a couple of months.
- Subacromial Decompression – The surgeon removes excess bone to free up the subacromial space. In this procedure, your bursa will still have enough space to glide over soft tissues.
Recovering from shoulder bursitis
Non-operative procedures typically go well for patients with shoulder bursitis. Symptoms usually resolve after a few weeks of physical therapy and activity modification.
Although, your age also plays a role in how fast you can recover. The older you are, the longer the recovery time. (4)
5 Tips to prevent shoulder bursitis
To avoid missing out on activities, here are a few tips to prevent shoulder bursitis:
- Always warm-up before starting any heavy physical activity
- Improve shoulder and trunk flexibility by doing range of motion exercises and stretching
- Maintain good physical conditioning especially if you are involved with overhead sports
- Gradually increase the intensity of your activities so that you don’t overdo them with your shoulders
- Get proper sleep, as this could reduce chances of sustaining an injury. (5)
Should I use ice or heat packs for shoulder bursitis?
When it comes to pain relief, both ice and heat are excellent choices. It’ll usually come down to the duration of the condition and if there is swelling. For patients with shoulder bursitis, an ice pack is a better option since it also addresses the swelling of the bursa.
How to tell which shoulder bursa is involved?
The shoulder has six different bursae, the most in any joint in the body. Musculoskeletal ultrasound is useful in locating which affected bursa is swollen. It is less costly and less invasive compared to other diagnostic tests. (6)
But, accuracy is dependent on the skill of the sonographer. (7)
How should I sleep with shoulder bursitis?
In a study made to measure the relation between sleep and shoulder blade pain, the best sleep position is sleeping on your back. This results in less stress to the shoulder joint as compared to sleeping at your side and lying face down. (8)
What can be mistaken as shoulder bursitis?
Different shoulder conditions can mimic the same symptoms of shoulder bursitis. Usually, this is because their affected structures are near a shoulder bursa.
Getting it checked by a medical professional can save you the hassle and worry of guesswork and hours on google. These conditions can be (9):
- Frozen Shoulder
- Calcific Tendinosis
- Long Head of Biceps Tendinosis
- Acromioclavicular joint osteoarthritis
- Shoulder Impingement
Shoulder bursitis is a bothersome condition to deal with. No type of injury or pain should affect how you live your life. We hope in this article we have given you the proper knowledge so that you can keep shoulder pain away.
- Virta, Lena et al. “Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden.” BMC musculoskeletal disorders vol. 13 17. 10 Feb. 2012, DOI: 10.1186/1471-2474-13-17
- Truong J, Mabrouk A, Ashurst JV. Septic Bursitis. [Updated 2021 Aug 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470331/
- Lee, Dong Gyu, and Jang Hyuk Cho. “Combined bursal aspiration and corticosteroid injection for rotator cuff tear patients unresponsive to conservative management: Case report.” Medicine vol. 99,34 (2020): e21759. doi: 10.1097/MD.0000000000021759
- Faruqi T, Rizvi TJ. Subacromial Bursitis. [Updated 2021 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541096/
- Milewski, Matthew D et al. “Chronic lack of sleep is associated with increased sports injuries in adolescent athletes.” Journal of pediatric orthopedics vol. 34,2 (2014): 129-33. DOI: 10.1097/BPO.0000000000000151
- Martinoli, Carlo et al. “US of the shoulder: non-rotator cuff disorders.” Radiographics : a review publication of the Radiological Society of North America, Inc vol. 23,2 (2003): 381-401; quiz 534. DOI: 10.1148/rg.232025100
- Read, John W, and Mark Perko. “Ultrasound diagnosis of subacromial impingement for lesions of the rotator cuff.” Australasian journal of ultrasound in medicine vol. 13,2 (2010): 11-15. doi: 10.1002/j.2205-0140.2010.tb00151.x
- Werner, Clément M L et al. “Subacromial pressures vary with simulated sleep positions.” Journal of shoulder and elbow surgery vol. 19,7 (2010): 989-93. DOI: 10.1016/j.jse.2010.04.039
- Allen, Gina M. “The diagnosis and management of shoulder pain.” Journal of ultrasonography vol. 18,74 (2018): 234-239. DOI: 10.15557/JoU.2018.0034