Understanding Shoulder Bursitis: A Common Cause of Shoulder Pain
The shoulder has a wide range of motion and flexibility due to the shape of the ball and socket joint. Support from soft tissue structures like the rotator cuff, a group of muscles and tendons connecting the shoulder blade to the upper arm, is needed for shoulder stability as well as helping with movement.
However, with all the movement the shoulder is capable of, structures like the rotator cuff tendons are at risk of rubbing and wearing themselves out. To try to prevent this the body uses a structure called a bursa. This is a very thin sac-like structure that exist pretty much wherever there is a risk of friction. Imagine a deflated balloon with a drop of oil inside - a bursa is a bit like this. The inner surfaces can glide smoothly over one another with the only space between each layer being a tiny layer of lubricating (synovial) fluid.
So far so good. The problem however is that sometimes the bursa can become inflamed - so called bursitis, and in the shoulder this is a common culprit behind shoulder pain. Shoulder bursitis can affect people of all ages, but it's more commonly seen in individuals over 40, especially those who engage in repetitive overhead activities or have a history of shoulder injuries. Both men and women are equally susceptible to developing shoulder bursitis.
There are several factors that can contribute to the development of shoulder bursitis:
Overuse or Repetitive Movements: Activities that involve repetitive overhead motions, such as painting, swimming, or throwing, can put strain on the shoulder joint and lead to bursitis over time.
Trauma or Injury: A direct blow to the shoulder or sudden impact can cause inflammation of the bursae, resulting in shoulder bursitis.
Underlying Conditions: Shoulder bursitis may also be associated with other underlying conditions, such as rotator cuff tears, calcifications, or inflammatory diseases like rheumatoid arthritis.
When someone experiences shoulder bursitis, it typically presents as pain and tenderness in the affected shoulder - often the outer shoulder into the upper arm, particularly with overhead movements. It may feel swollen and stiff, making it difficult to move the arm comfortably and patients will frequently complain of disrupted sleep.
To diagnose shoulder bursitis a thorough history and physical examination needs to be undertaken to explore for underlying causes. Imaging studies including X-rays may be requested to rule out other issues like arthritis. Ultrasound allows soft tissues in your shoulder, including the rotator cuff and bursa to be seen and assessed dynamically. It may also be necessary to arrange an MRI.
Diagnostic injections can be helpful since injecting a numbing medication into the shoulder joint or bursa can help to confirm which structures are causing the pain.
Treatment options for shoulder bursitis focus on treatment of the underlying cause, reducing inflammation and relieving pain:
Rest and Activity Modification: Avoiding activities that aggravate the shoulder and allowing time for rest can help alleviate symptoms.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) or injections including corticosteroid may be prescribed to reduce pain and inflammation in the shoulder.
Physical Therapy: Gentle stretching and strengthening exercises can help improve flexibility and range of motion in the shoulder, while also promoting healing of the inflamed bursae.
Injections: Injections into the bursa can be very effective at settling pain associated with inflammation. This will often be a steroid (cortisone) injection. Platelet Rich Plasma (PRP) and hyaluronic acid injections are other alternatives to steroid injections that may be considered. Often the greatest effect from the injection is that it can create a window of opportunity to engage in exercise rehabilitation. Remember, the bursitis is often due to an underlying problem, such as damage to a rotator cuff tendon. The injection can therefore allow you to start the tendon rehabilitation having settled the pain coming from the inflamed bursa. If this window is not used effectively, the underlying problem is likely to persist and as a result the bursal inflammation may creep back.
It is sometimes necessary to have more than one injection although if pain continues to recur despite repeated injections, an opinion from a shoulder surgeon may be appropriate.
Shoulder bursitis can be a painful and very bothersome condition. Bursitis can be triggered by a wide range of conditions or activities and so the key is to firstly determine the underlying diagnosis. Treatment should aim to settle the bursal inflammation whilst also addressing the underlying cause. Thankfully, most patients experience significant improvement in their symptoms over time.
