Also referred to as:
- Shoulder Bursitis
- Subdeltoid Bursitis
- Subacromial Bursitis
Shoulder Anatomy
The shoulder joint is a ball and socket joint made up of the humerus (upper arm bone), scapula (shoulder blade) and clavicle (collarbone).
Below the collarbone lies a small, fluid-filled sac known as a bursa. The bursa acts as a cushion to reduce friction between the bone and surrounding muscle tissues.
So what is Subacromial Bursitis?
Subacromial bursitis is a condition where the bursa in the shoulder becomes inflamed due to increased friction between the muscle tendons and bone. When bursitis occurs, the bursa enlarges due to an increase of synovial fluid and collagen in the area. As such, any movement that places pressure on the bursa will cause pain.
Causes
Some examples of common causes include:
- Subacromial Impingement
- Repetitive overhead movements
- Direct fall onto the shoulder
- Autoimmune Disease (i.e. rheumatoid arthritis)
Bursitis can be divided into 2 key categories: Acute and Chronic
- Acute
- Typically arises from an accident or injury, resulting in the sudden onset of pain.
- Chronic
- May arise from inflammatory conditions or overtime from repetitive/ overuse injuries.
Signs and Symptoms
Common signs and symptoms include:
- Pain over the front or outside of the shoulder
- Pain with shoulder movement
- Shoulder stiffness or a feeling of swelling
- Pain when sleeping on the affected side
- Pain or pinching with overhead shoulder movement
Diagnosis
A thorough history and physical examination are vital in the clinical diagnosis of this condition. Your physiotherapist will ask you about your medical history, and gain an understanding of your daily activities. From there, they will undertake an objective assessment to evaluate your range of motion, strength, and response to special testing.
Imaging is not routinely used in the diagnosis of Subacromial Bursitis. However, can be used to provide further information.
- X-Rays:
- May be performed to rule-out other causes of shoulder pain such as a fracture, or areas of bony growth
- Ultrasound and/or Magnetic Resonance Imaging (MRI):
- Can be used to evaluate the thickness of the bursa and identify inflammation.
Management
Non-operative management is usually the first line of treatment for Subacromial Bursitis. Strategies can include physiotherapy, cortisone injections and non-steroidal anti-inflammatory medications (NSAIDs).
Operative management is usually reserved for presentations non-responsive to conservative management.
How can Physiotherapy help?
Physiotherapy can help you to improve the strength of the muscles around the shoulder that support the bursa. This is particularly important in helping you to maintain muscle strength, range of motion, and preventing complications related to prolonged rest.
Physiotherapists can also provide valuable information around:
- Rest and activity modification
- Pain management
- Posture and ergonomics
Physiotherapy management will incorporate a range of techniques such as soft tissue release, joint mobilisations, stretching, and strengthening exercises to help address the underlying cause of your bursitis.
How to Manage Common Aggravating Factors
| Aggravating Activity | Strategies to Reduce Symptom Aggravation |
| Repetitive Movements | Breaking up tasks into short intervals with adequate rest in between Preferencing the unaffected arm or alternating between sides |
| Overhead Reaching | Using a stool or step ladder |
| Sustained Sitting | Having an active break every 30 minutes, and completing regular mobility exercises Being mindful of posture |
Prognosis
The prognosis for Subacromial Bursitis is good, with the majority of cases resolving with physiotherapy management. In general, the condition is self-limiting with little impact on long-term function.
Prevention
Some strategies that you can take to help prevent any episodes of shoulder bursitis include:
- Warming up the shoulder prior to activity
- Performing regular stretching and strengthening exercises
- Taking breaks during repetitive activities
- Wearing a shoulder brace to ease tension on the shoulder
References
Klatte-Schulz, F., Thiele, K., Scheibel, M., Duda, G. N., & Wildemann, B. (2022). Subacromial Bursa: A Neglected Tissue Is Gaining More and More Attention in Clinical and Experimental Research. Cells, 11(4), 663. https://doi.org/10.3390/cells11040663
Faruqi T, Rizvi TJ. Subacromial Bursitis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541096/
Williams CH, Jamal Z, Sternard BT. Bursitis. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513340/