Why Shoulder Bursitis Happens and How You Can Treat It

Shoulder bursitis is inflammation of a bursa, a fluid-filled sac, in the shoulder joint. The bursa provides padding between bones, tendons, and ligaments to reduce friction and improve joint movement throughout the body. There are multiple bursae in the shoulder, but this condition most commonly affects one called the subacromial bursa.

Types

The three general types of shoulder bursitis include:

• Chronic: This is the most common type and develops gradually over time due to repetitive irritation of the bursa.
• Acute: Also known as traumatic bursa, this is the least common type, but it is seen in athletes who constantly rub against a hard surface or bend the joint repeatedly.
• Infected: This is caused by bacteria in the bursa. If the infection spreads it can cause serious complications.
  

Symptoms of Shoulder Bursitis

The primary symptom of shoulder bursitis is pain. The type of discomfort varies, but some of the common sensations include:

• Dull/aching pain at rest and during everyday activities
• Pain that radiates along the front of the shoulder and the outside of the upper arm
• Sharp pain with lifting or reaching overhead
• Pain when palpating (touching) the shoulder
• Increased pain at night, especially when lying on the affected arm

Other symptoms of shoulder bursitis include:

• Muscle weakness
• Decreased range of motion
• Swelling in the joint
• Bruising (from trauma)
• Numbness/tingling (if swelling presses on nearby nerves)

Symptoms of traumatic bursitis come on suddenly following an accident or injury such as a player hitting the shoulder on a hard surface during a sporting event.

Bursitis caused by infection can also cause:

• Warm skin
• Redness (at the shoulder and along the arm)
• Fatigue
• Fever
• Nausea
• Swelling that spreads down the arm
  

Causes

Shoulder bursitis commonly develops over time from repetitive shoulder motion or overuse. It is common in people who perform manual labor requiring frequent reaching overhead or lifting, as well as athletes who participate in sports that require throwing a ball or using a racquet.

Other causes of bursitis include:

• Direct trauma, such as a fall onto the affected shoulder
• Shoulder impingement (shoulder pain caused by friction between a tendon and the shoulder blade)
• Calcium deposits in the shoulder joint
• Rotator cuff tendonitis or tendon tears
• Infection

Bursae can also become inflamed as a side effect of other medical conditions, such as:

• Autoimmune conditions (such as rheumatoid arthritis)
• Gout
• Pseudogout
• Uremia (blood issue caused by kidney failure)
• Diabetes

Diagnosis

Shoulder bursitis is diagnosed by a healthcare provider, such as an orthopedist, based on a review of your symptoms and a physical exam. Your provider may perform shoulder-specific tests to determine which structures in your shoulder joint are causing your pain.

In some cases, additional imaging might be required to help rule out broken bones or tendon tears that can occur with bursitis. These tests can include:

• X-rays
• Magnetic resonance imaging (MRI)
• Computed tomography (CT scan or CAT scan)

Diagnosing bursitis caused by infection can also include blood tests and joint aspiration (draining fluid from joints) to determine the type of bacteria in the bursa.

Treatment

Shoulder bursitis usually heals within three to four weeks with treatment. Most people see improvement with conservative treatment, and symptoms may even go away on their own. In some cases, though, medication or medical treatments are needed.

At-home treatment focuses on reducing pain and inflammation, such as:

• Rest: Avoid activities that increase pain.
• Ice/heat: Apply ice several times per day, 20 minutes at a time, for the first 48 hours, particularly if your bursitis resulted from trauma. You can apply heat to the shoulder if you have chronic pain.
• Gentle range of motion exercises: Reduce stiffness by moving your shoulder in pain-free directions.
• Over-the-counter medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve (naproxen), Advil or Motrin (ibuprofen), and Bayer (aspirin), can help reduce symptoms.

With shoulder bursitis, you should not engage in activities that require repetitive movements, which can make the inflammation worse and put you at risk for further injury.

Also, during recovery from shoulder bursitis, avoid heavy lifting, throwing with the injured arm, performing across-body movements with the arm (like swinging a golf club), and sleeping on the shoulder.

If your bursitis is caused by infection, your provider will prescribe antibiotics.

Cortisone Injections

Cortisone shots provide long-term pain relief for an inflamed bursa. For chronic conditions, your healthcare provider may recommend one or more cortisone injections to ease swelling and pain. The most significant downside is that cortisone injections may weaken tendons. Repeated cortisone injections should be considered with care.

Physical Therapy

Physical therapy is a standard treatment for shoulder bursitis. Interventions can include:

• Modalities to reduce pain (such as ultrasound, electrical stimulation, and light therapy)
• Manual therapy to increase joint mobility and flexibility
• Exercise to increase range of motion (such as shoulder pulley exercises) and strength
• Posture exercises to reduce pressure on your bursa and other shoulder structures

Joint Aspiration

In traumatic bursitis, a large amount of fluid may accumulate around the joint after the accident or injury. Joint aspiration is a procedure that removes the fluid with a needle. This takes pressure off the shoulder joint, relieving pain and allowing for better movement.

Surgery

Although rarely used, subacromial decompression surgery can treat shoulder bursitis. This procedure is performed arthroscopically, using several tiny incisions and tools to remove the damaged bursa. Bone spurs, or growths that contribute to bursitis, can also be shaved down during this surgery. Physical therapy can help restore function after this procedure.

Prevention

While certain factors may put you at risk for shoulder bursitis, there are steps you can take to reduce the chances that you will develop a problem.

• Stretch your shoulder before physical activity.
• Build strength in your shoulders with targeted exercise.
• Take breaks between training activities.
• Rest when you feel pain or discomfort to avoid further injuring your shoulder.

Summary

Shoulder bursitis occurs when tiny sacs of fluid in the shoulder joint (bursae) become inflamed. This condition can develop from repetitive reaching or lifting overhead or as a result of trauma (such as a fall). In rare cases, bursitis is caused by bacterial infection. Symptoms include pain, swelling, decreased range of motion, weakness, and difficulty performing daily tasks.

Shoulder bursitis is diagnosed with a physical exam, including special orthopedic tests to help your healthcare provider identify the source of your shoulder pain. Sometimes, additional imaging tests (such as X-rays or MRI) are required. Treatment includes home remedies, medications, physical therapy, and in severe cases, surgery. Sometimes, shoulder bursitis improves on its own.