Shoulder pain can be frustrating! We use our arms so much and often don’t realise how shoulder injuries can impact so many things like sleeping, combing your hair and putting on clothes just to name a few.
People who have been experiencing shoulder bursitis along with other injuries like shoulder tendinopathy/ tendinopathies experience the problem for months and in some cases even years. This can make us feel sad as health professionals when you understand there is so much that can be done to help.
Shoulder pain can get in the way of living life the way you want to and it doesn’t have to be that way. Learn more about Shoulder Bursitis and the available treatment so you can get back to moving and living the way you want to again.
Shoulder Pain Myths
What is Shoulder Bursitis?
To understand Shoulder bursitis, it is helpful to understand what a bursa is in the first place…
A bursa is a fluid filled sack that protects the movement of a tendon over a bony prominence.
Shoulder bursitis is the swelling and irritation of the bursa. As there is a close relationship with the surrounding tendons, people who experience shoulder bursitis will also experience shoulder tendinitis/ tendinopathy or small tendon tears in the area.
What are the symptoms of Shoulder Bursitis?
People that have shoulder bursitis will experience a feeling of soreness in the shoulder and in most cases, will increase in intensity with use. Often, pain can be in intermittent periods and eventually slowly increase in frequency over time. Once the injury is established, the pain can persist.
People who have shoulder bursitis will experience pain within the initial period of activity (for example, within the first few movements after being inactive like moving your arm with your first movements after waking) or with prolonged activity like hanging up a load of washing.
People will also report that pain will improve with rest. For this reason, people can soon find themselves withdrawing from the activities they enjoy as a coping strategy for the pain. This is usually the hardest part as it can make people sad about not doing the activities they want to and can create anxiety about future physical ability.
In established cases, people with shoulder bursitis will keep their arm locked in a tight position and prevent the arm from swinging as a means to prevent forces of the body travelling through the surrounding tendons and eventually the bursa to reduce pain. This can lead to behaviour change, loss of strength and over time people that experience shoulder bursitis may find themselves completely avoiding use of their arm all together.
Shoulder bursitis can affect either one or both shoulders at the same time and people who experience shoulder bursitis will often report associated:
– Neck pain,
– Back pain,
– Arm pain,
– Wrist and hand pain
As shoulder bursitis is associated with activity avoidance and disordered movement, it is the reason that many people can also experience other injuries and painful conditions at the same time.
How is Shoulder Bursitis diagnosed?
Most people are diagnosed with shoulder bursitis after visiting their doctor and after imaging such as MRI or ultrasound are completed. Following this, the doctor will often refer to a movement focused therapist such as a physiotherapist for treatment.
It is helpful to know that imaging, such as MRI and ultrasound is not required to diagnose and begin treatment with a physiotherapist. A good therapist who has experience working with shoulder bursitis can apply a wide range of physical tests within a consultation to diagnose, understand more about the causes of the bursitis and begin treatment within the first session, without the need for further imaging.
What causes Shoulder Bursitis?
The purpose of a bursa in the body is to reduce friction from tendons over bony prominences, however when too much friction occurs, the bursa itself becomes irritated and this is what leads to bursitis.
What causes this increased friction?
No two cases of bursitis are the same and there are multiple influencing factors that may contribute to a person developing an injury such as shoulder bursitis. These may include:
– Repetitive occupational/ recreational activities
– Reduced shoulder muscle strength
– Lifting heavy things/ lifting children
– Other pre-existing injury (For example, an unaddressed neck and back injury that has had an effect on shoulder strength and function)
– Use of walking aids such as crutches/ walking sticks or frames can increase load on the shoulder
Who gets Bursitis?
People of any age can experience hip bursitis, although it is most common in the 30-60 year old age group.
What are the treatment options for Shoulder Bursitis?
It is common for people in Australia to receive Cortisone injection for shoulder bursitis, contrary to clinical evidence for best outcomes.
Although Cortisone injection can, in some cases, relieve pain, it does not address the cause of the bursitis. For this reason, sadly people can have injection, after injection, after injection without a long term resolution to the problem.
Because people are different and because no two cases of shoulder bursitis are the same, it is important that a person experiencing shoulder bursitis has a thorough assessment with a practitioner experienced in helping people with shoulder bursitis.
Successful long term management of shoulder bursitis must begin with a thorough assessment and understanding of the influencing factors that have caused the problem (see causes above).
As every case of shoulder bursitis has multiple influencing factors, a successful management plan will usually involve addressing multiple factors such as:
– Load/ activity management
– Occupational/ recreational/ behaviour advice
– Strength and conditioning exercises
People with different physical requirements and different levels of ability should always be offered an individualised treatment.
If you are experiencing shoulder bursitis, the most important thing to consider is what you want to be able to do again (whether it be lifting things, household duties, working activities or recreational activities like playing golf) because it’s the things that we want to do in life, that bring us happiness.
More on shoulder pain
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Understand and learn more with the following resources:
– The 3 biggest causes of neck pain
Proactive Health & Movement