Shoulder Bursitis 101

Shoulder Bursitis is the inflammation of the shoulder bursa. Your shoulder bursa is a pocket of fluid which reduces friction in the movement of your shoulder. It is commonly caused by overuse or incorrect use of the shoulder joint.

I see countless clients who present with shoulder pain thinking they have bursitis. Typically I would use an ultrasound scan to confirm the diagnosis. A painful cortisone injection or, operation* to remove part of a bone in the shoulder called the acromion may follow in a worst case scenario.  Many  people may suffer from shoulder bursitis seeing the problem recur weeks, months or years after an injury or at worst, it may make no significant difference to their lifestyle at all.

Why might your shoulder bursa became sore in the first place?

The shoulder is amazingly complex in that it perfectly balances the mobility and stability required to perform a variety of recreational, occupational and general day-to-day movements.  There is a great reliance on the muscular system to maintain the healthy balance around your shoulder girdle.

The bursa (along with one of your rotator cuff tendons) is found in a bony “tunnel” called the subacromial space (ie the tunnel is under the acromion – the bone we mentioned earlier).

Simply put, if this tunnel is narrowed for any reason, the bursa effectively gets squashed.  If the space is maintained, the bursa and tendon can function appropriately.

Incorrect posture, repetitive actions and generally over time the muscles can become imbalanced  , which effectively can narrow this tunnel, causing stress and eventually pain from the damaged bursa or tendon.

Injecting the bursa with cortisone can reduce inflammation but this is only a quick fix to mask the pain; the issue of the tunnel size remains, and the problem often comes back.  If you undergo surgery to remove part of the acromion (which is the roof of the tunnel), the muscle imbalance still remains.  The pain from the immediate stress on the bursa often recedes, however the muscle imbalance can still cause stress on other tissue instead which may eventually become sore.

How can you prevent shoulder bursitis?

In my opinion, bursitis on its own can often be simply managed through dedicated exercise, improving posture, muscle strength and stability. There is a spectrum of severity that may require anti-inflammatories or even a cortisone injection to settle down the immediate pain, however no matter how you get your pain to settle, if you address the underlying reason you developed bursitis, you will have far less chance of a recurrence down the track –prevention is the key.

My key taking? Learn to understand your body and when a muscle imbalance becomes apparent, consult a physio for advice and treatment to target and fix this imbalance. 

Jeremy Hobbs – Physiotherapist and Director, Back In Motion Mount Barker

* As a disclaimer, there are indeed structural reasons why part of your acromion may need to be removed (ie if the shape you were born with is encroaching upon the bursa or underlying tendon) and indeed, a cortisone injection can relieve pain related to inflammation in your shoulder.