Subacromial bursitis

A bursa is a fluid field sack, designed to reduce friction between tendons and bones. Bursae can be found in various locations around the body.

The subacromial bursa is probably the most pain sensitive structure in the shoulder. It is located between the top of the rotator cuff tendons and the bony roof of the shoulder (the acromion).

Repeat injuries or repeated incidents of acute bursitis can cause chronic shoulder bursitis. It’s the most common type of shoulder bursitis. You may have periods without symptoms and then have symptom flare-ups (return of symptoms) that last several months. Over time, this ongoing inflammation can cause arm and shoulder weakness.

Sometimes shoulder bursitis can be seen with diagnostic ultrasound. This will show in engorgement of the bursa with fluid. Bursitis is a condition which can come and go with physical stress. Often a patient may have bursitis shown on ultrasound, but one or two weeks later, it may not be present, only to return a month after that.

During shoulder impingement, the rotator cuff tendons can be impinged and damaged, but the bursa can also be impinged. when this happens the cells lining the bursa irritated and produce more fluid into the bursa. This stretches the walls of the bursa, causing pain.

Bursitis is an inflammatory issue. Inflammatory pain is characterised by resting pain, such as difficulty getting to sleep or waking up in pain during sleep.

Sometimes patients are referred for an ultrasound-guided Cortizone injection into the bursa to decrease inflammation. This is sometimes successful. However, this does not solve the problem. To have a long-term solution to bursitis it's critical to control the impingement situation.

At Melbourne shoulder physiotherapy, we will assess the factors causing the impingement and deal with them. This will prevent further episodes of bursitis.