Shoulder pain is such a common situation that even 70% of people will have this type of pain at least once throughout their lives. Among the various possible causes of shoulder pain, shoulder bursitis, also called subacromial or subdeltoid bursitis, is one of the most common.
Bursitis is the name we give to the inflammation of the bursa, also known as the synovial pouch, which is a small bag filled with fluid that acts as a buffer, reducing friction between the muscles, tendons and bones that surround the joints.
In this article we will explain what shoulder bursitis is, what are its causes, symptoms, shoulder physiotherapy treatments and prevention methods.
What is Shoulder Bursitis
The shoulder is one of the most complex joints in our skeleton, formed by three bones and several muscles, tendons and ligaments.
The shoulder is a joint that allows the movement of the arm, in a multiaxial manner, which allows us a great range of movements. To facilitate sliding, reduce friction and cushion the impact between the anatomical structures of the shoulder there is the bursa, which is a small bag with lubricating fluid, which in the specific case of the shoulder is below the acromion (upper edge of the scapula bone ) and the deltoid muscle, which is why it is called subdeltoid subacromial bursa (see illustration below).
Shoulder bursitis, also known as subacromial bursitis, is a problem that occurs when the subacromial subdeltoid bursa inflames. Often, bursitis is part of a picture we call shoulder impingement syndrome, which is a pathology of the shoulder in which not only the bursa becomes inflamed, but also the muscles that pass through the subacromial space show signs of tendonitis (inflammation of tendons).
The impingement syndrome and bursitis in the shoulder can be caused by several factors, including trauma or excessive and repetitive movements of the shoulder, as in the case of volleyball players, swimmers, golfers, tennis players, gymnasts, bodybuilding practitioners, painters, gardeners, carpenters, cleaning employees or any professional activity that requires frequent and repetitive movements of the shoulders.
Shoulder bursitis can also originate in systemic inflammatory diseases, such as polymyalgia rheumatica, gout, rheumatoid arthritis, lupus, psoriatic arthritis and scleroderma.
Symptoms of Shoulder Bursitis
Shoulder pain and difficulty moving the arm are the most common symptoms of subacromial bursitis and shoulder impingement syndrome
The pain of bursitis is usually found in the upper arm, along the deltoid muscle and can radiate almost to the elbow. The pain tends to start soft, worsening over days or weeks. The pain of bursitis or clamping syndrome gets worse with arm movement, especially when you’re trying to elevate it above the shoulder line. With time the pain becomes present even with the arm at rest. At night, pain can interrupt sleep, especially at times when the patient sleeps with the body turned to the side, on the affected shoulder.
With the worsening of pain, the patient begins to restrict their movements with the arm. Scratching the back, wearing a jacket, closing the zipper of a dress, closing the bra or raising the arm above the head becomes very painful attitudes. As the patient feels pain, the tendency is that little by little use less affected shoulder. This restriction of shoulder movements can lead to the appearance of a second problem, which is adhesive capsulitis, also known as frozen shoulder. We explain the adhesive capsulitis in a separate article: ADHESIVE CAPSULITE – Frozen Shoulder .
If the bursitis in the shoulder is not treated in its initial stages, the inflammation tends to be chronic and more difficult to resolve. Prolonged inflammation of the bursa can cause calcium deposition in the bursa, causing calcification, stiffness and loss of ability to protect the joint.
Shoulder Bursitis Diagnosis
The diagnosis of shoulder bursitis and impingement syndrome is usually made after the joint evaluation of the clinical history, physical examination and imaging tests.
During the physical examination, the orthopaedist will do some tests, moving the shoulder in various ways to try to identify which movements cause the most pain. Another test commonly used is the injection of intraarticular anesthetic. In the case of bursitis or shoulder impingement syndrome, the application of the anesthetic relieves pain and allows the patient to have the normal range of motion again. In adhesive capsulitis, pain relief is not accompanied by the return of movements.
The x-ray of the shoulder does not diagnose bursitis, but it helps to rule out other possible causes of shoulder pain, bone lesions or osteoarthritis (Lee: ARTHROSIS – Symptoms, Causes and Treatment ).
If after the full clinical evaluation the orthopedist still has doubts regarding the diagnosis, the best image exam to evaluate the bursa and the tendons is the magnetic resonance of the shoulder.
Shoulder Bursitis Treatment
The initial treatment of subacromial bursitis involves rest, application of local ice and pain control with analgesics and anti-inflammatories.
If the initial treatment does not have satisfactory results within 72 hours, or if the patient has contraindications for the use of anti-inflammatory drugs, the doctor may choose to apply an intra-articular injection of corticosteroids. In many cases of shoulder bursitis, a single intra-articular injection leads to the healing of the box.
After pain treatment, physiotherapy Melbourne is needed for the patient to restore muscle strength and range of motion of the shoulder.
In rare cases of chronic bursitis that do not respond to any type of treatment, surgery to remove the bursa may be the solution.
Shoulder Bursitis Prevention
After effective treatment of bursitis in the shoulder, some measures can be applied to reduce the risk of recurrence:
Physical activity directed by a professional to strengthen the muscles.
Stretching with professional orientation.
Avoid tasks that require repetitive shoulder movements for a long time.
If it is not possible to avoid tasks that overload the shoulders, try at least to do some pauses during the day.
Avoid activities that cause pain in the shoulder.
Use both hands to hold tools or heavy objects.
Do not keep the shoulder immobilized for long periods of time.
Try to maintain good posture throughout the day, especially during work.
Start rest and treatment when shoulder pain arises.