Shoulder Bursitis - Management to Return to Function
Shoulder bursitis is a common condition that causes severe pain in the shoulder region, disabling the person from usual activities due to a restricted mobility. Evidence suggests a prevalence reaching 22% in the general population, with the most occurrence in athletes and laborer's.
Before embarking on the recovery journey, our team at Gym Therapy wants to share with you a complete overview of Shoulder Bursitis, so you are well-informed of your condition or if you suspect anyone you know is suffering from it. So stick to the end as in this article, we will explore the anatomy of the shoulder joint, discuss the signs and symptoms of Shoulder Bursitis, discuss differential diagnosis and discuss various diagnostic and treatment approaches to effectively manage this painful condition.
Anatomy of the Shoulder
The foremost thing we need to know for an understanding of Shoulder Bursitis is the anatomy of the shoulder joint. The shoulder joint is an intricate structure comprising several bones, ligaments and muscles. The upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle) come together to form the shoulder joint. The shoulder blade (scapula) forms a socket in which the head of the humerus sits, allowing the joint a normal range of movement. Shoulder rotator cuff muscles stabilise the joint while allowing the joint movement. These muscles are namely the supraspinatus, infraspinatus, teres minor and subscapularis.
An interesting structure that requires our special attention, in this case, is a fluid-filled sac known as the Subacromial bursa. It reduces friction between rotator cuff tendons and bony prominence on the scapula (known as Acromion). This structure allows smooth shoulder movement and it is this very structure that is the center of inflammation in the Shoulder bursitis. Other bursas i.e. Subcoracoid bursa present in the shoulder can also become inflamed leading to Shoulder Bursitis.
Signs & Symptoms: Recognising Shoulder Bursitis
If you are an athlete, a manual laborer or any person who performs frequent arm elevation or carries weight overhead and experiences shoulder pain, you might be suffering from Shoulder Bursitis. Inflammation of the subacromial bursa may be due to an accident (trauma), overuse or pre-existing joint disease. This results in immobility of the shoulder, weakness, pain and sometimes swelling in the shoulder region.
An understanding of the signs and symptoms of Shoulder bursitis aids in timely diagnosis leading to appropriate treatment. Some of the usual markers include:
- Pain: Individuals affected with Shoulder Bursitis experience pain in the impacted shoulder. This sharp, stabbing pain can aggravate when lifting objects or performing overhead movements. Subacromial bursitis pain is usually located on the top of the shoulder whereas other bursas may cause pain in the armpit or underside of the shoulder.
- Restricted Range: Inflammation of the bursa interrupts the smooth movement of the shoulder joint leading to stiffness and functional disability.
- Weakness: Shoulder muscles are observed to weaken due to Bursitis, which further hinders daily activities especially those that requires overhead strength.
Differential Diagnosis
The shoulder joint is a complex structure comprising many structures. Thus pinpointing the specific cause of shoulder pain is essential for appropriate treatment and management. Conditions with similar symptoms are:
- Tendonitis
- Rotator Cuff Tears
- Frozen Shoulder (Adhesive Capsulitis)
- Arthritis
- Cervical Radiculopathy
Imaging may be indicated in certain cases depending on your symptoms & history. This may include:
● X-ray to rule out the possibility of a bone fracture.
● Ultrasounds help visualise soft tissues to a better extent and hence can visualise bursa inflammation.
● MRI scan is the gold standard as it provides detailed images of bursae and surrounding tissues helping to rule out the possibility of a rotator cuff tear.
Therapy & Rehabilitation
An individualised plan is important to help you get back to full function. During the acute phase, approaches like icing, rest and anti-inflammatory medications are essential to provide relief to acute injury. Manual therapy which aims to gently mobilise joints and soft tissues aiming to reduce stiffness by alleviating muscle tightness. Electrotherapy may also be used to locally relieve pain
During latter phases of rehabilitation, we shift the attention to muscle-strengthening exercises which aim to provide support for the joint, thus improving stability and aiding recovery. Postural re-training and stability training may also be indicated to improve long-term shoulder health and functional performance.
Prevention of Shoulder Bursitis
It is a well-known saying that prevention is better than cure. As discussed earlier, frequent overhead motion is a causative factor of Shoulder Bursitis - managing your overhead loading to avoid sudden spikes in overhead loading can reduce the risk of Shoulder Bursitis. For those with an occupation requiring frequent overhead movement, frequent rests can assist in managing strain and reduce overload. A specific, functional warm up is also important prior to completing overhead strengthening or functional workouts.
To Finish
Shoulder Bursitis can lead to disability impairing a person’s ability to perform tasks and effect quality of life. Early diagnosis and management is important to reduce aggravating factors and inflammation. Holistic management that includes functional, postural, strength and stability re-training is important to not only recondition the joint but prevent re-injury.
If you’re experiencing symptoms of Shoulder Bursitis or are struggling with overhead function, consider a consultation at GymTherapy for an integrated plan towards healthier, functional shoulders.
Happy lifting 🏋️
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References
van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995;54:959
Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon) 2003;18:369–79
McCausland C, Sawyer E, Eovaldi BJ, et al. Anatomy, Shoulder and Upper Limb, Shoulder Muscles. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL)
Harrison AK, Flatow EL. Subacromial impingement syndrome. J Am Acad Orthop Surg. 2011;19:701–8
Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther. 2000;30:126–37
Disclaimer: This blog is for informational purposes and should not be considered a substitute for professional medical advice. Please consult with our qualified healthcare providers for personalised recommendations related to your specific condition and needs.
