Bursitis is an inflammation of the bursae. The bursae are small, fluid-filled sacs found near joints. They act as a cushion between moving parts in the joint to stop muscles, bones, and tendons from rubbing together.
When a shoulder bursa gets irritated, it becomes inflamed and grows in size. This means there is less space in the shoulder for muscles and tendons to move around, which can cause pain and a loss of movement in the shoulder.
Overuse of the shoulder joint, an injury, or chronic conditions, such as rheumatoid arthritis, can cause shoulder bursitis.
This article gives key information about symptoms and management of shoulder bursitis.
Shoulder bursitis may cause symptoms such as limited range of movement in the shoulder, and pain at the tip of the shoulder.
Key symptoms of shoulder bursitis include:
- pain around the outside or tip of the shoulder
- pain when the shoulder is touched
- reduced range of movement in the shoulder joint
- swelling and redness around the shoulder
- shoulder pain when the arm is raised, such as reaching shelves or washing hair
The pain may become worse at night, especially when lying on the affected shoulder. It may also get worse after the shoulder has been kept still for a while.
Shoulder bursitis is most common in the subacromial bursa. This is a large bursa at the tip of the shoulder. It helps with smooth movement when the arm is lifted above the head.
If the above symptoms are coupled with a fever, the bursa may be infected. This is called septic bursitis, and a doctor should investigate the situation.
Bursitis of the shoulder is treatable at home or by a doctor. Symptoms are often relieved using the RICE method: rest, ice, compression, and elevation.
More specifically, the following treatments may help with shoulder bursitis:
- Anti-inflammatories: Aspirin or ibuprofen can reduce swelling and discomfort in the shoulder.
- Rest: Reducing shoulder movement can stop the bursa from getting more irritated and give it time to heal. A shoulder brace can help. Along with rest, some gentle shoulder exercises can stop the joint from becoming stiff.
- Ice packs: When an injury or overuse causes bursitis, an ice pack can help within the first 5 days. Apply ice every 15 to 20 minutes at 4 to 6-hour intervals to reduce pain and swelling.
- Steroid injections: If symptoms persist, a doctor can inject corticosteroids in or around the bursa. This reduces swelling and discomfort. The effects may be temporary, but treatment can be repeated several times.
- Surgery: When shoulder bursitis is long-term and does not respond to treatment after 6 to 12 months, surgery may be suggested as a final option. Surgery can repair damage and reduce the pressure in the bursa.
Professional guidance from a physical therapist may help to reduce the risk of injury, and ensure a speedy recovery.
Once the pain starts to go away, some gentle strengthening exercises can help speed up recovery. Doing daily exercises can keep the shoulder active without putting too much pressure on the shoulder joint.
Common exercises include:
- Stand upright and raise the shoulders toward the ears. Hold for 5 seconds.
- Squeeze the shoulder blades together behind the back. Hold for 5 seconds.
- Pull the shoulder blades downward toward the heels. Hold for 5 seconds.
- Repeat 10 times.
- Stand upright in an open doorway.
- Take the injured arm and bend the elbow 90 degrees with your hand in front of you, as if to shake someone's hand.
- Press the back of the hand into the doorframe.
- Hold for 5 seconds.
- Repeat 15 times.
- Find a stick. A broom handle is perfect for this exercise.
- Stand upright and hold the stick in both hands with palms facing down.
- Slowly raise the stick overhead while keeping the arms straight.
- Hold for 5 seconds and slowly lower the arms.
- Repeat 10 times.
Causes and risk factors
The most common cause of shoulder bursitis is repetitive movement or overuse of the shoulder joint. Physical injury, such as a car crash or fall, can also cause bursitis.
Hobbies that put repeated stress on the shoulder, such as baseball, tennis, knitting, and weight training, can cause bursitis. People with manual professions are more prone to bursitis of the shoulder, including athletes, painters, and musicians.
When bursitis of the shoulder is caused by a physical injury, it can be treated within a few days.
Recovery time is longer if bursitis is caused by overuse. It may take several weeks or more to heal, especially if the shoulder joint is still being used.
Shoulder bursitis may take longer to heal if other shoulder problems are present, including tendinitis or bone problems.
Bursitis can be chronic when it is caused by medical conditions, particularly rheumatoid arthritis.
In some cases, an MRI scan may be used to diagnose bursitis of the shoulder.
When diagnosing bursitis of the shoulder, a doctor may ask about risk factors, including medical history, profession, and hobbies.
Diagnostic tests can include:
- Physical exams: A doctor can often diagnose bursitis through testing the location of the pain, muscle strength, and the current range of movement in the shoulder joint.
- Radiography: An X-ray does not look at the bursa itself, but it can be used to rule out bone damage or arthritis as possible causes of shoulder pain. This can be very important for choosing the right kind of treatment.
- MRI scans: An MRI scan can show any inflammation in the bursa or any damage to the bone and surrounding tissue. MRI scans are often not required for diagnosis.
- Fluid testing: Fluid can be taken from the bursa and tested to rule out infection. This process is called aspiration.
The key to preventing bursitis of the shoulder is reducing strain on the shoulder joint. The following prevention strategies can help:
- warming up and stretching the shoulder before exercising or using the shoulder joint repeatedly
- strengthening the shoulder muscles by using gentle exercises
- building up slowly when starting any new activity that places strain on the shoulder
- taking frequent breaks when using the shoulder repeatedly
- improving posture to keep shoulder muscles active and reduce joint pressure
Full recovery from shoulder bursitis is very likely. Symptoms usually subside within a few weeks.
Bursitis of the shoulder usually responds well to rest and anti-inflammatory medication. When there is another shoulder problem, such as bone problems or tendinitis, longer-term physical therapy may be needed.
Finding the right activity level is key to preventing bursitis and improving the outlook. People should look out for key lifestyle triggers that can cause bursitis to avoid overuse of the shoulder joint.