The shoulders are composed of several structures, such as muscles and tendons, ligaments and joints. One of the often ignored structures are the bursae. These small pouches can become inflamed. It can cause significant pain, reduces range of motion and affects a person’s ability to use their arm. Of the various types of bursitis, shoulder bursitis remains one of the most common types.
What is shoulder bursitis?
Shoulder bursitis is inflammation of the small fluid-filled pouches (bursae) that are located in the shoulder. These pouches are located in and around joints throughout the body. It helps to reduce friction between different parts of the musculoskeletal system (muscles, tendons and bones). Bursitis can occur at many of the joints, such as the elbow, hip or knee, but shoulder bursitis is one of the more commonly affected locations.
There are several bursae in and around the shoulder. The most commonly affected bursa in shoulder bursitis is the subacromial bursa. It is one of the larger of the shoulder bursae. Most of the time, shoulder bursitis is due to overuse and injury but can sometimes arise with an infection. Bursitis is usually an acute condition but can be chronic (long term), especially when associated with chronic conditions like rheumatoid arthritis.
Read more on bursitis.
Signs and Symptoms
Shoulder bursitis symptoms tend to develop gradually over weeks or months but can sometimes arise suddenly within days. The symptoms of shoulder bursitis includes:
- Shoulder pain is the main symptom of shoulder bursitis. It is usually described as pain on the outside or tip of the shoulder. The pain also tends to worsen with use of the arm, especially when raising it above the head. It may also radiate down the arm to the elbow and/or wrist.
- Tenderness is another common symptom. This is pain elicited with pressure near the inflamed bursa. Pain also worsens when lying on the affected side.
- Swelling and redness are two other features of inflammation. It may vary depending on the severity of the inflammation as well as the location of the inflamed bursa.
- Restricted movement of the arm is another symptom. This is in part due to the pain with certain movements, like raising the hand above the head.
A fever along with the symptoms mentioned above may indicate septic bursitis (infection). It is usually a more severe form of shoulder bursitis and requires medical attention as soon as possible.
Read more on shoulder pain.
Causes of Shoulder Bursitis
Overuse is one of the most common causes of shoulder bursitis. This can result in repetitive stress injury where the trauma is ongoing but minor. Sudden strain like with lifting heavy weights, even if not repetitive, can also result in bursitis. More severe injuries to the shoulder like through a fall is another common cause of shoulder bursitis.
The bursae play an important role in the functioning of the musculoskeletal system. With movement causing body parts to rub against each other, bursae helps to reduce this friction. It has a similar lining to some joints, known as the synovium. This lining prodces fluid that fills the bursae. When inflamed, the lining produces excess fluid which causes the bursa to swell.
Sometimes shoulder bursitis can become a chronic problem. This is more likely to occur with inflammatory diseases like rheumatoid arthritis and systemic lupus erythematosus (SLE). The bursa may also become inflamed due to uric acid crystals that form in the pouch (gout). An infection of the bursa (septic bursitis) is uncommon and is most likely due to bacteria like Staphylococcus aureus.
Treatment for Shoulder Bursitis
The choice of treatment depends on the severity of the bursitis as well as the cause. Acute bursitis may not always require medical or surgical treatment. Instead conservative measures can help to ease the inflammation and allow the bursitis to resolve on its own. However, these measures may not be sufficient for severe cases of acute or chronic bursitis.
R.I.C.E. stands for rest, ice, compression and elevation. This is a useful approach for most soft tissue injuries and not only bursitis. Resting the arm and affected shoulder as well as applying ice packs over the affected area several times in the day should be done as directed by a medical professional.
- Anti-inflammatory drugs like ibuprofen and aspirin.
- Corticosteroids which are usually injected.
- Antibiotics for infectious shoulder bursitis (septic bursitis).
Surgery is not frequently conducted for shoulder bursitis. It is reserved for the severe cases that do not respond to conservative and medical options. Fluid may be drained from the affected bursa but sometimes the bursa needs to be removed surgically (bursectomy), particularly when infected.
Calcified Shoulder Bursitis
Untreated and persistent bursitis can result in complications. One of these complications is calcification of the affected bursa. Over time this can cause extensive hardening of the bursae. Depending on the degree of calcification, conservative measures including physical therapy may be helpful. Alternatively surgery may be necessary to remove the calcified bursae.
Prevention of Shoulder Bursitis
Shoulder bursitis is not always preventable. However, the following measures may be helpful in minimizing strain and injury that can cause bursitis. The most important approach to preventing acute shoulder bursitis is to warm up the mucles of the arms and shoulders prior to any strenuous physical activity. This is not always possible but should be done before workouts.
Furthermore it is important to strengthen the shoulder muscles once the condition resolves to prevent recurrence. Try to avoid lifting heavy weights if not conditioned to do so. Seek assistance from others where possible. If repetitive activity is necessary then there should be several breaks to avoid bursitis. The activity should be gradually introduced to allow the various structures to strengthen over time.
Bursitis caused by inflammatory conditions like rheumatoid athritis can be prevented if the condition in question is properly treated and managed. This may require medication and in rare instances surgery which reduces the risk of developing bursitis as well as other complications. It is important to seek advice about preventative measures directly from a medical professional.
Resting and even immobilizing the arm may be helpful to prevent further bursitis and even assist with its resolution over time even without drugs.