What is bursitis?
Bursitis is inflammation of the bursa. The bursa is a small, fluid-filled sac that acts as a cushion between bones, tendons, joints and muscles near your joints. The bursa allows smooth gliding between these structures.
Bursitis can occur in any part of your body. It’s most common in your elbows, knees, hips, ankles and shoulders. Bursitis can be caused by chronic overuse, injury, arthritis or infection. It leads to pain, inflammation, swelling and tenderness.
Some common types of bursitis include:
– Elbow bursitis (olecranon bursitis): Swelling of the bursa at the tip of your elbow. Also called miner’s or student’s elbow.
– Hip bursitis (trochanteric bursitis): Swelling of the bursa on the outside point of your hip bone. Also called weaver’s bottom.
– Knee bursitis: Swelling of the bursa in the front of your knee, often caused by kneeling for long periods. Also called housemaid’s knee.
– Shoulder bursitis (subacromial bursitis): Swelling of the bursa between your shoulder bone and rotator cuff muscles. The most common location for bursitis.
What is shoulder bursitis?
Shoulder bursitis, also called subacromial bursitis, affects the bursa that sits between the top of your humerus bone (upper arm bone) and your acromion. The acromion is part of your scapula bone that forms the highest point of your shoulder.
Several bursae are located around your shoulder joint. Subacromial (sub=below, acromion=tip of shoulder) bursitis affects the subacromial bursa right under the acromion. This is the most common spot for shoulder bursitis to develop.
The subacromial bursa helps the motion of your arm as it rotates in your shoulder socket. When inflamed, it can cause significant shoulder pain. The pain may occur at the top, front or side of your shoulder.
Causes
Shoulder bursitis often results from:
– Overhead motions. Repeatedly lifting your arm overhead during certain sports, jobs or chores can strain or injure the bursa.
– Improper form. Bad posture and improper shoulder mechanics during repetitive motion can damage the bursa.
– Direct trauma. Falls or hits directly on your shoulder can damage the bursa.
– Bone spurs. Bony projections off the acromion bone can rub and irritate the bursa.
– Rheumatoid arthritis. The chronic inflammation can cause bursitis.
– Infection. A skin infection near the bursa can spread to the bursa.
Risk factors
Factors that increase your risk of developing shoulder bursitis include:
– Sports that involve repetitive overhead motions. Examples include swimming, tennis, volleyball and pitching.
– Jobs or hobbies with repetitive overhead motions. Examples are carpentry, house painting, laying tile, playing drums or lifting heavy objects.
– Trauma or injury to the shoulder area. This can damage the bursa.
– Rotator cuff injuries. Harm to the rotator cuff tendons can alter shoulder mechanics and strain the bursa.
– Poor posture. Slouched position can impinge the bursa during overhead activities.
– Bone spurs. Bony projections off the tip of the shoulder can rub the bursa.
– Age. Older adults are at higher risk due to less muscle elasticity and thinning of soft tissues.
Common symptoms
Signs and symptoms of shoulder bursitis include:
– Pain in the shoulder or upper arm area, especially with overhead reaching or lifting.
– Tenderness or soreness when pressing on the top/side of the shoulder.
– Stiffness and reduced range of shoulder motion, making it hard to lift your arm.
– Sharp shoulder pain when lying on the affected side.
– Difficulty sleeping due to shoulder discomfort.
– A popping or snapping sensation when moving the shoulder.
– Bursitis may cause a bump (swelling) at the tip of the shoulder.
– The pain may radiate down the arm toward the elbow.
Diagnosing shoulder bursitis
To diagnose shoulder bursitis, your doctor will ask about your symptoms and medical history. Make sure to mention any jobs, sports or hobbies that involve repetitive shoulder motions.
Your doctor will do an exam of your shoulder to assess:
– Points of tenderness – Where you feel pain when the shoulder is pressed.
– Range of motion – How far you can move your arm in different directions.
– Strength – Any weakness when moving or holding against resistance.
– Crepitation – Grinding, cracking or popping sounds during movement.
– Inflammation – Any swelling, redness or warmth around the shoulder joint.
Imaging tests
Your doctor may order imaging tests if the diagnosis is uncertain. These can detect bursitis and help rule out other problems like a tear. Imaging tests for shoulder bursitis include:
– X-ray. Can show bone spurs or calcium deposits that irritate the bursa.
– MRI. Provides a view inside the shoulder joint to assess soft tissues like the bursa.
– Ultrasound. Uses sound waves to create images of structures in the shoulder to check for bursitis.
Removing fluid for analysis
If an infection is suspected, your doctor may use a syringe to draw fluid from the bursa for lab analysis. This is called needle aspiration or drainage. It reduces swelling and pressure, and allows testing for bacteria.
Treating shoulder bursitis
Most cases of shoulder bursitis can be treated at home with rest, ice packs, over-the-counter anti-inflammatory medication and avoiding aggravating activities. Your doctor may recommend:
– Applying ice for 10-15 minutes several times per day. This reduces inflammation and pain.
– Taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve). These help relieve pain and swelling.
– Getting a cortisone injection into the bursa if the bursitis is severe. The steroid drug reduces inflammation.
– Using a shoulder sling or splint to protect the bursa for 1-2 weeks. This allows it to rest and heal.
– Doing gentle exercises and stretches once pain decreases to improve mobility and prevent stiffness.
– Having physical therapy for specific shoulder exercises and modifications once acute inflammation subsides.
At-home treatments
Home remedies and lifestyle measures that can help treat shoulder bursitis include:
– Applying a cold compress or ice pack for 10-15 minutes several times per day. Wrap the ice in a thin towel to protect your skin.
– Taking over-the-counter NSAIDs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve). Follow dosage instructions.
– Gently massaging the shoulder, avoiding any very tender spots. This helps loosen stiff muscles.
– Doing light range-of-motion exercises for the shoulder and neck when the pain starts decreasing. Avoid lifting your arm overhead.
– Resting the shoulder as much as possible for a few days. Avoid activities that aggravate the pain.
– Sleeping with a small pillow under the shoulder to prevent lying directly on the sore spot.
– Applying moist heat for 15 minutes prior to doing exercises or gentle stretches. Use a warm towel or heating pad.
Prevention tips
You can take steps to prevent shoulder bursitis:
– Warm up shoulder muscles before sports or strenuous activity. Start with light motions and gradually increase intensity.
– Pay attention to shoulder mechanics during repetitive overhead motions. Keep elbows bent and avoid reaching too far.
– Take frequent breaks during prolonged overhead activities to rest the shoulder.
– Maintain proper posture when sitting at a desk or computer.
– Do shoulder stretches and strengthen rotator cuff and scapular muscles to keep them flexible.
– Use ice and over-the-counter anti-inflammatories after unaccustomed or increased shoulder activity.
– Consider physical therapy to learn ideal shoulder mechanics and exercises tailored to your activities.
Bursitis surgery and procedures
If conservative treatments fail to relieve your shoulder bursitis, your doctor may recommend:
– Needle aspiration to drain fluid from the inflamed bursa. This reduces swelling and pain.
– Cortisone injection into the bursa to suppress inflammation. Usually provides longer relief than other injections.
– Surgery to remove the entire bursa if it remains severely inflamed. Called bursectomy.
– Shoulder arthroscopy to smooth bone spurs rubbing on the bursa. Improves space for the bursa to glide freely.
– Tendon or ligament repair if shoulder instability or tears are contributing to bursitis.
Needle aspiration
With this office procedure, the doctor inserts a thin needle into the bursa, guided by ultrasound imaging. Fluid is withdrawn to reduce swelling, pressure and irritation. The doctor may inject a local anesthetic and corticosteroid medication. Repeat aspirations may be needed.
Cortisone injection
Cortisone is a strong anti-inflammatory steroid medication. Injecting it directly into the inflamed bursa provides localized relief. It decreases fluid buildup and irritation of the bursa lining.
The injection involves cleaning the skin with antiseptics, then guiding a thin needle into the bursa while confirming proper positioning using ultrasound. Potential side effects include temporary pain flares, lightening of the skin, weakening of tendons, and rarely, infection.
Bursectomy surgery
This surgery may be considered if the problematic bursa remains severely inflamed after more conservative treatments. Bursectomy involves surgically removing the entire affected bursa. This is an outpatient procedure done under general anesthesia or a nerve block.
It allows surgeons good access to assess damage and remove inflamed tissues. Removing the bursa alleviates friction and irritation. The space usually fills with scar tissue after surgery. Physical therapy helps recover range of motion and strength.
Arthroscopic surgery
Shoulder arthroscopy is minimally invasive surgery done through small incisions using a camera. It allows smooth bone spurs and damaged soft tissues to be visualized and treated.
During arthroscopy for shoulder bursitis, the spur irritating the bursa is smoothed down to open up space for normal movement. Associated problems like rotator cuff tears may also be repaired. Arthroscopy typically enables quicker recovery than open surgery.
Long-term outlook and complications
With proper rest and treatment, most cases of shoulder bursitis resolve well over one to two weeks. It may take longer if there is significant swelling or damage. Recurrence is common if activities that aggravate it are resumed too early. Chronic bursitis may persist if underlying causes like bone spurs or poor mechanics continue.
Potential complications include:
– Frozen shoulder. Bursitis can progress to a stiff, frozen shoulder if not rested adequately during the acute inflammation phase.
– Muscle atrophy. Disuse of the shoulder during prolonged bursitis may cause surrounding muscles to shrink and weaken.
– Tendonitis. Untreated bursitis can lead to inflammation of rotator cuff tendons.
– Osteoarthritis. Chronic shoulder irritation increases risks for joint damage over time.
– Infection. Rarely, the bursa may become infected (septic bursitis), requiring antibiotic therapy.
When to see a doctor
See your doctor if shoulder pain and limited mobility do not improve after a few days of home treatment, or if you experience:
– Sudden severe shoulder pain without an obvious cause
– Severe swelling or redness around the shoulder joint
– Pain that interferes with sleep or daily activities
– Fever, chills or other signs of infection
– Shoulder weakness, numbness or tingling
– Inability to lift your arm without significant pain
– Popping, catching or locking sensations in the shoulder
– Pain from minor bumps or pressure on the shoulder
– A history of arthritis, diabetes, or immune system disorder
Conclusion
Bursitis is inflammation of a small fluid-filled sac called the bursa which cushions shoulder tendons and muscles. Subacromial shoulder bursitis is inflammation of the bursa under the tip of the shoulder. It causes localized pain worsened by overhead arm movements.
Shoulder bursitis often results from repetitive overhead reaching and sports. It can also occur from direct trauma, bone spurs, poor posture, arthritis or infection. Diagnosis involves evaluating shoulder pain, tenderness, range of motion and swelling. Sometimes imaging tests are needed.
Most cases of shoulder bursitis can be treated at home with rest, ice, anti-inflammatory medication and avoiding aggravating motions. Gentle exercises can help prevent stiffness once pain decreases. Steroid injections, needle aspiration or surgery may be considered if bursitis persists.