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  • Kris Krotiris

Understanding Shoulder Bursitis

Updated: Feb 12

Many of us will experience shoulder pain at some point in our lives. A common cause of this discomfort is a condition known as shoulder bursitis. Let's explore what this means and how you can recognise and tackle it.

Understanding Shoulder Bursitis

A bursa is a fluid-filled sac designed to reduce friction between tissues in your body. In your shoulder, the 'sub-acromial bursa' is situated under the acromion, a part of your shoulder blade. When this bursa becomes inflamed, you're dealing with shoulder bursitis, characterised by pain and restricted movement.

An anatomy picture of a normal shoulder joint vs shoulder bursitis

Identifying Bursitis as the Source of Your Shoulder Pain

Shoulder bursitis is one of the most common causes of shoulder pain, however there are many other causes of shoulder pain to be aware of, with some of the more common including:

  • Rotator cuff injury (this often co-exists with bursitis and can be difficult to distinguish without imaging)

  • Frozen shoulder

  • Referred pain from other areas

  • Labral tear

A detailed physical examination is essential to accurately diagnose the cause of shoulder pain. This might include an ultrasound, X-ray, or MRI. Nonetheless, there are specific symptoms that could suggest bursitis:

  • Pain during arm elevation. A painful arc is often seen, which is described as the experience of sharp or severe shoulder pain that occurs within a specific range of arm elevation, often felt when lifting the arm from the side up to overhead (see picture below).

  • Pain located on the outer shoulder or the top of your arm.

  • Discomfort with overhead activities.

  • Pain when lying on the affected side.

Shoulder Bursitis: A painful arc
The painful arc

What causes bursitis?

Shoulder bursitis occurs when the stress exerted on the subacromial bursa surpasses its tolerance threshold. This threshold is affected by various factors, including:

  • Adaptations in muscles and tendons around the shoulder from recent physical activities or exercises and;

  • The tissue's recovery capability, which is influenced by overall health factors such as smoking status and medical conditions like diabetes, as well as sleep quality and nutrition.

This excessive strain (which exceeds the body's capacity to recover) may result from specific acute activities that impose unusual stress on the shoulder. This most commonly includes:

  1. Lifting heavy objects overhead without proper technique or preparation, which can overload the shoulder muscles and bursa.

  2. Engaging in repetitive sports movements, such as the serving action in tennis or the overhead swing in badminton, which can stress the same shoulder areas repeatedly.

  3. Performing extensive yard work or gardening, especially activities involving reaching or lifting above shoulder level, like trimming hedges or trees.

  4. Participating in manual labor tasks, such as construction work or painting ceilings, where the arms are frequently raised above the head for prolonged periods.

  5. Practicing improper posture while working at a computer for long hours, leading to shoulder and neck strain that affects the bursa.

  6. Carrying a heavy backpack or shoulder bag on one side consistently, which can skew posture and put uneven stress on the shoulder.

It is also important to consider that shoulder posture can influence the strain encountered by the bursa. This is discussed in further detail in another blog post. Poor posture, such as rounded shoulders or forward head position, can alter the biomechanics of the shoulder joint, leading to increased pressure and friction on the subacromial bursa for a given load. This altered biomechanical environment in the presence of a sudden significant increase in tissue strain, often encountered in some of the situations described above, may exacerbate the risk of developing a bursitis.

Treating Shoulder Bursitis

The good news is that shoulder bursitis can be effectively treated. Recovery starts with a thorough physiotherapy assessment to pinpoint the contributing factors. The treatment plan often includes:

  • Strengthening and stretching exercises.

  • Postural corrections.

  • Modifications to certain activities.

With appropriate treatment, you can significantly reduce the symptoms of shoulder bursitis, leading to improved function and pain relief.

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