What Is Shoulder Bursitis?
Shoulder bursitis (or subacromial bursitis) is the inflammation of the bursa located between the acromion and the tendons of the rotator cuff.
This inflammation leads to pain, restriction of movements, and, in advanced cases, inability to lift the arm. Shoulder bursitis can appear independently or in combination with other conditions, such as supraspinatus tendonitis or a rotator cuff tear.
Anatomy and Role of the Shoulder
The shoulder joint is the most mobile in the human body, as it allows a wide range of movements. It consists of the humeral head, the glenoid of the scapula, and is surrounded by a joint capsule, namely a thin lining containing synovial fluid. This fluid functions as a lubricant, reducing friction between the structures of the shoulder. Around the joint, there are swelling, tendons, and bursae, small sacs filled with fluid that function as “cushions” absorbing pressures and friction. When one of these bursae becomes inflamed, bursitis is caused.
Causes of Appearance
The causes of bursitis are distinguished into traumatic and degenerative, with the latter appearing more frequently in people over 40 years of age.
Traumatic causes
In many cases, bursitis is the result of a sudden or repetitive strain on the shoulder. Specifically:
- Repetitive movements above the shoulder level, such as those required in sports like tennis, volleyball, swimming, or weightlifting, exert continuous pressure on the tendons and bursae. The continuous mechanical irritation leads to inflammation, micro-tears, and fluid accumulation in the bursa.
- Occupations that require working with hands above the head, such as painters, electricians, construction workers, and laborers, significantly strain this specific area, increasing the probability of bursitis appearing.
- Sudden or excessive strain, for example, after intense physical activity or weightlifting without proper warm-up, can cause acute irritation of the bursa.
- Injuries or falls with the hand extended or supporting on the floor cause mechanical trauma to the joint and secondary inflammation of the bursa.
Degenerative causes
Bursitis can also arise gradually, due to tissue wear and alterations related to age or the general condition of the organism. For instance:
- Wear over time leads to degenerative alterations of the rotator cuff tendons and the bursa itself, making them more vulnerable to inflammation even after a minor load.
- Poor body posture (e.g., kyphosis or forward rounding of the shoulders) and scapular dysfunction alter the mechanics of the shoulder, increasing friction between structures and predisposing to chronic inflammation.
- Metabolic and endocrine conditions, such as diabetes mellitus, thyroid disorders, or hypercholesterolemia, affect microcirculation and the quality of soft tissues, making them more susceptible to inflammation.
- Prolonged shoulder immobilization (e.g., after a fracture or surgical intervention) can lead to adhesions and bursitis due to reduced blood supply and mobility.
Symptoms
Shoulder bursitis manifests with a variety of symptoms that affect both the mobility and daily functionality of the upper limb.
The intensity and duration of symptoms may vary depending on the stage of inflammation (acute or chronic) and the level of joint strain.
Main symptoms
- Shoulder pain: The primary symptom is pain in the anterior and superior surface of the shoulder, which worsens during lifting or rotation of the hand. The pain can be sudden in acute inflammation or low-intensity but persistent in chronic cases. It frequently radiates towards the arm or down to the elbow, without, however, passing the wrist.
- Night pain: Many patients report intense pain at night, especially when lying on the affected shoulder. Night pain is characteristic of bursitis and constitutes an indication of active inflammation.
- Sensation of stiffness or “catching”: The shoulder often presents stiffness and reduced range of motion, particularly during the early morning hours. Patients may feel that the arm “gets stuck” or “does not lift freely.”
- Mobility restriction: Shoulder movement, especially during abduction (sideways lifting) and external rotation, causes pain and is restricted. This affects the performance of simple daily movements, such as dressing, combing hair, or lifting objects.
- Tenderness to palpation: The anterior and superior surface of the shoulder is painful to pressure, while in certain cases, mild swelling or a sensation of warmth may be observed in the area due to inflammation.
- Muscle weakness: In chronic or recurrent bursitis, a progressive weakening of the shoulder muscles is observed, mainly of the deltoid and the rotator cuff. This leads to reduced endurance and easier fatigue during the use of the upper limb.
- Reduced functionality: The patient encounters difficulty performing simple activities such as putting on clothes, reaching objects on a shelf, or supporting themselves with one hand. If left untreated, the condition can lead to secondary stiffness or “frozen shoulder” (adhesive capsulitis).
Diagnosis
The diagnosis of shoulder bursitis is of essential importance for the correct and effective therapeutic approach.
Because the symptoms of bursitis can resemble those of other conditions, such as supraspinatus tendonitis, a rotator cuff tear, or “frozen shoulder,” a systematic evaluation by a specialized orthopedist is required.
The diagnostic procedure usually includes the following stages:
- Detailed medical history to identify the cause or type of strain.
- Clinical examination, during which the orthopedist evaluates the range of motion and provokes characteristic pain with special tests.
- Shoulder ultrasound, which reveals the inflammation of the bursa and any fluid in the area.
- Magnetic resonance imaging (MRI), in cases where coexistence of tendonitis or a rotator cuff tear is suspected.
Treatment Management
The treatment of shoulder bursitis is personalized and depends on the severity of the symptoms, the duration of the inflammation, and the cause that provoked it. The goal of treatment is to reduce pain and inflammation, restore shoulder mobility, and prevent recurrences or complications, such as chronic stiffness or “frozen shoulder.”
In most cases, the approach is initially conservative, while in more resistant or chronic conditions, interventional or arthroscopic treatment may be needed.
Conservative Management
In most cases, treatment is conservative and includes:
- Rest and avoidance of movements that cause pain.
- Anti-inflammatory drugs (oral or topical).
- Injections of corticosteroids or PRP (platelet-rich plasma) into the bursa, for faster reduction of inflammation.
- Physical therapy, with mobilization techniques, stretches, and strengthening of the rotator cuff muscles.
- Cryotherapy or thermotherapy, depending on the stage of inflammation.
Surgical Treatment
In cases of chronic or resistant bursitis, where symptoms persist despite conservative treatment, arthroscopic bursectomy or debridement is applied.
Through small holes, the surgeon removes the inflamed bursa, reducing friction and restoring smooth shoulder mobility.
The recovery after arthroscopy is rapid, with minimal postoperative pain and return to activities in 7-10 days.
Rehabilitation
Physical therapy constitutes a fundamental stage for full rehabilitation. The program includes:
- Stretching exercises for the gradual restoration of the range of motion.
- Strengthening exercises for the muscles of the rotator cuff and the scapula.
- Education on proper body posture and techniques to avoid shoulder strain.
The duration of rehabilitation varies from a few days to 2 weeks, depending on the severity and type of inflammation.