Subacromial bursitis, often referred to as shoulder bursitis or subdeltoid bursitis, is one of the most common causes of shoulder pain. It occurs when the small fluid-filled sac (the bursa) that sits beneath the acromion and deltoid becomes irritated and inflamed. The bursa normally acts as a cushion, reducing friction between the rotator cuff tendons and the bony structures of the shoulder. When inflamed, however, it leads to pain, stiffness, and difficulty using the arm, particularly for overhead activities.
Physiotherapy for subacromial bursitis is a key part of recovery. Physiotherapists play an essential role in restoring shoulder movement, improving strength, and reducing the chance of recurrence.
Key Facts
- Subacromial bursitis is one of the leading causes of shoulder pain in adults. 🔗
- It is often linked with shoulder impingement syndrome and rotator cuff dysfunction.
- Most cases improve with physiotherapy and do not require surgery.
Risk Factors
- Age over 40
- Occupations requiring repetitive overhead work
- Poor posture (rounded shoulders, forward head position)
- Rotator cuff weakness or injury
- Previous shoulder injuries
- Autoimmune or inflammatory disorders
Symptoms
- Pain at the front or outer aspect of the shoulder
- Pain when lifting the arm, particularly overhead
- Shoulder stiffness or a feeling of fullness/swelling
- Night pain when lying on the affected side
- A painful “pinching” sensation with certain movements
- Reduced ability to reach behind the back
Aggravating Factors
- Repetitive overhead movements
- Reaching or lifting heavy objects
- Prolonged sitting with rounded shoulders
- Sleeping on the affected side
- Sudden increases in activity or training load
Causes
Subacromial bursitis usually results from repetitive irritation of the bursa due to poor movement mechanics, shoulder muscle weakness, or posture-related strain. Common causes include:
- Subacromial impingement, where the rotator cuff tendons and bursa are compressed beneath the acromion
- Repetitive overhead movements, such as painting, swimming, or throwing
- Direct trauma, such as a fall onto the shoulder
- Chronic overuse from occupations involving repetitive lifting
- Autoimmune and inflammatory conditions, including rheumatoid arthritis
Bursitis can be classified as:
- Acute bursitis: caused by a sudden injury or trauma, leading to rapid onset of pain.
- Chronic bursitis: develops over time due to repetitive strain, poor biomechanics, or ongoing inflammation.
How Is It Diagnosed?
Diagnosis of subacromial bursitis is primarily clinical and begins with a thorough history and physical assessment. A physiotherapist will examine shoulder movement, muscle strength, and conduct specific tests to reproduce symptoms.
The hallmark finding is pain with overhead movements and tenderness over the subacromial space. Imaging may be used to rule out other shoulder conditions or confirm inflammation, but it is not always necessary.
Investigations & Imaging
- X-ray
- Used to rule out fractures, arthritis, or bone spurs that may contribute to impingement.
- Ultrasound
- Assesses bursal swelling, fluid build-up, and rotator cuff involvement.
- MRI
- Provides detailed images of the bursa, tendons, and joint structures to confirm inflammation.
Grading / Classification
- Acute bursitis
- Sudden onset following trauma or overload, often with severe pain and reduced movement.
- Chronic bursitis
- Gradual development due to repetitive irritation, often associated with postural and muscular imbalances.
Physiotherapy Management
Exercise
Targeted shoulder physiotherapy exercises for subacromial bursitis aim to strengthen the rotator cuff and scapular stabilisers. Stretching the chest and posterior shoulder helps reduce mechanical stress on the bursa. Exercises are gradually progressed from gentle mobility to resistance training.
Activity Modification
Activity modification is crucial in early stages. A physiotherapist will advise on reducing aggravating overhead tasks, breaking up repetitive work, and pacing return to sport or activity.
Manual Therapy
Joint mobilisation, soft tissue massage, and trigger point release help restore shoulder movement and reduce compensatory tension in surrounding muscles.
Postural Retraining
Poor posture, particularly rounded shoulders and forward head position, narrows the subacromial space. Physiotherapists provide strategies and ergonomic advice to improve shoulder positioning.
Bracing & Taping
Shoulder taping or supportive bracing may be used to unload the bursa during flare-ups and provide proprioceptive feedback to improve posture.
Dry Needling
Can reduce pain and muscle tension in associated muscles such as the upper trapezius and deltoid, indirectly decreasing load on the bursa.
Shockwave
Occasionally used in persistent cases to reduce inflammation and promote healing of the surrounding soft tissues.
Heat & Ice
Ice is sometimes recommended in the acute phase to reduce swelling, while heat may help in chronic bursitis to relax tight muscles.
Education
Education is a critical part of physiotherapy management. Patients are taught how to manage flare-ups, gradually restore function, and prevent recurrence through long-term shoulder conditioning.
Other Treatments
- Corticosteroid injections: Used in cases of severe inflammation to provide short-term pain relief, allowing physiotherapy to progress more effectively.
- Anti-inflammatory medication (NSAIDs): Can assist in managing pain and swelling but should be combined with physiotherapy for long-term results.
Surgery
Surgery for subacromial bursitis is rare and reserved for cases unresponsive to prolonged conservative management. Procedures may include arthroscopic bursectomy (removal of the inflamed bursa) or acromioplasty (shaving part of the acromion to create more space).
Prognosis & Return to Activity
With appropriate physiotherapy, most cases of subacromial bursitis improve within weeks to a few months. Chronic cases may take longer but respond well to consistent rehabilitation. Early physiotherapy intervention leads to faster recovery and reduces the chance of recurrence.
Complications
- Persistent shoulder pain
- Stiffness and reduced mobility
- Progression to rotator cuff pathology
- Difficulty with work or sport participation
Preventing Recurrence
- Regular shoulder strengthening and stretching exercises
- Warming up before activity
- Avoiding prolonged overhead tasks without breaks
- Maintaining good posture and workstation ergonomics
- Using correct lifting techniques
- Gradual progression of training loads
When to See a Physio
- Shoulder pain does not improve with rest within a few days
- Pain interferes with sleep or daily activities
- Overhead movement is restricted or painful
- You experience repeated episodes of shoulder pain
- You have a history of shoulder injury and ongoing stiffness