The subacromial bursa
Bursae are small sacs with a thin layer of fluid that reduce friction between tendons and bone. In the shoulder, the subacromial bursa lies under the acromion, the bony tip of the shoulder blade, and over the supraspinatus tendon of the rotator cuff.
Because the bursa and the tendons are so close, bursitis and rotator cuff tendinopathy usually occur together and are often grouped under the term subacromial pain or impingement.
Symptoms
- Pain on the outer side of the shoulder that can spread down to the elbow.
- Pain when lifting the arm out to the side or overhead, often worst in the middle of the movement.
- Pain lying on the affected side at night; see shoulder pain from sleeping on your side.
- Difficulty putting on a coat, reaching behind your back or into a high cupboard.
- Tenderness on the outer shoulder.
Causes
- Repetitive overhead work, such as painting, plastering or stacking shelves.
- Sports with overhead movements: swimming, tennis, volleyball and throwing.
- A sudden increase in gym training, especially overhead pressing.
- A fall onto the shoulder or arm.
- Age-related changes in the tendons and bone.
- Less commonly, inflammatory arthritis, gout or infection.
How it is diagnosed
A physiotherapist or doctor diagnoses shoulder bursitis from the history and examination, including movement, strength and specific tests. An ultrasound can show a thickened bursa and the condition of the tendons, and an X-ray may be used to look for calcium deposits or arthritis; see calcific tendonitis.
It is important to distinguish bursitis from a frozen shoulder, which causes marked loss of movement in all directions, and from rotator cuff tears.
What you can do at home
- Modify activities that cause pain, especially overhead and reaching, without stopping using the arm.
- Use ice for 15 minutes after activity, or heat if it eases stiffness.
- Take simple painkillers if appropriate.
- Sleep on the other side or on your back with a pillow under the arm.
- Keep the shoulder moving gently within comfort.
Exercises that help
- Pendulum swings: lean forward and let the arm hang and swing gently.
- Isometric external rotation: press the back of the hand into a wall with the elbow bent.
- Band external rotation: see shoulder external rotation.
- Shoulder blade setting and rows: strengthen the muscles that position the shoulder blade.
- Progressive lifting: gradually return to raising the arm with light weights.
Exercises should cause no more than mild discomfort that settles within 24 hours. See rotator cuff exercises.
Medical treatment
If pain prevents exercise, a steroid injection into the bursa, often guided by ultrasound, can reduce pain for several weeks and allow rehabilitation to progress. Injections are used sparingly. Anti-inflammatory medicines may help some people for a short time.
Surgery, such as removing bone from under the acromion, has not been shown to be better than exercise for most people and is rarely recommended.
Recovery time
Most people improve within 6 to 12 weeks of a structured exercise programme, although tendon problems can take longer to fully settle. Returning gradually to overhead work and sport, rather than all at once, reduces the risk of a flare.
Adjusting work, gym and sport
- Bring work closer to you and lower shelves so you lift less above shoulder height.
- Take regular breaks from overhead and repetitive tasks.
- In the gym, reduce overhead pressing and wide-grip bench press temporarily and focus on rows and rotator cuff work.
- For swimmers and tennis players, reduce volume and review technique with a coach.
- Return to full loads gradually, increasing by around 10% a week.
These changes reduce the compression on the bursa while the exercise programme builds tendon capacity.
When to see a doctor
- A hot, red, swollen shoulder with fever.
- Sudden weakness or inability to lift the arm after a fall.
- Severe pain at night that is not eased by any position.
- Pain with numbness or tingling down the arm.
- No improvement after 6 weeks of treatment.
Key points to remember
- Shoulder bursitis causes outer shoulder pain when lifting the arm and at night.
- It usually occurs together with rotator cuff tendon irritation.
- Progressive exercise is the main treatment; injections can help settle pain.
- Most people improve within 6 to 12 weeks without surgery.
Questions about shoulder bursitis
These answers are general information and do not replace an examination or individual medical advice.
What does shoulder bursitis feel like?
An ache on the outer shoulder and upper arm, worse lifting the arm, reaching and lying on it.
How long does shoulder bursitis last?
Most cases improve within 6 to 12 weeks with exercise and activity changes.
Should I rest my shoulder with bursitis?
Reduce painful activities but keep moving. Complete rest leads to stiffness.
Is heat or ice better for shoulder bursitis?
Ice after activity may ease pain; heat can relax stiff muscles. Use what helps you.
Can shoulder bursitis go away on its own?
It can, but targeted exercise speeds recovery and reduces recurrence.
Is shoulder bursitis the same as impingement?
They overlap. Both describe irritation of the bursa and rotator cuff under the acromion.
Can massage help shoulder bursitis?
Massage may ease surrounding muscle tension, but exercise is the main treatment.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.