About Shoulder Bursitis

Overview

Shoulder bursitis is a common inflammatory condition that causes pain in the shoulder joint. It occurs when the bursae, which are small fluid-filled sacs that cushion the tissues around the joints, become swollen and inflamed. This can lead to symptoms such as shoulder pain, swelling, redness, and limited range of motion. Shoulder bursitis can be caused by repetitive overhead activities, minor trauma like falls, overuse of the shoulder joint, or underlying conditions like rheumatoid arthritis. Resting the affected joint and avoiding activities that put pressure on it can help with recovery. Physical therapy and injectable medication may also be recommended. However, certain exercises can worsen shoulder bursitis, so it's important to consult with a healthcare professional for personalized advice.

Causes and Risk Factors

Shoulder bursitis is primarily caused by repetitive movement or overuse of the shoulder joint. Physical injuries, such as falls or car accidents, can also lead to bursitis. Additionally, certain hobbies and professions that involve repeated stress on the shoulder, like baseball, tennis, knitting, weight training, painting, and playing musical instruments, can increase the risk of developing shoulder bursitis.

Non-modifiable risk factors for shoulder bursitis, which are factors that cannot be controlled to reduce the risk of developing the condition, include:

Age: Older adults are more prone to developing shoulder bursitis due to shoulder joint wear and tear.
Gender: Some studies suggest that men may have a higher risk of shoulder bursitis.
Previous injury: A past shoulder injury can increase the likelihood of developing bursitis.
Anatomy: Natural variations in shoulder structure can make some people more susceptible.

Modifiable risk factors for shoulder bursitis, which are factors that can be controlled to reduce the risk of developing the condition, include:

Repetitive overhead movements: Jobs or sports that involve frequent overhead lifting or motion can increase the risk.
Poor posture: Slouching or improper shoulder positioning can put extra stress on the shoulder joint.
Muscle weakness or imbalance: Weak or uneven shoulder muscles can strain the bursa.
Inadequate warm-up: Skipping proper warm-up before exercise can increase the chance of irritation.
Overuse of the shoulder: Excessive or continuous use of the shoulder without enough rest.

Remember, it's important to consult with your healthcare professional for a proper diagnosis and personalized advice on your risk factors for developing shoulder bursitis.

Symptoms

The most common early symptoms of shoulder bursitis include:

Pain around the outside or tip of the shoulder
Pain when the shoulder is touched
Reduced range of movement in the shoulder joint
Swelling and redness around the shoulder
Shoulder pain when the arm is raised, such as reaching shelves or washing hair

As shoulder bursitis progresses or becomes more severe, additional symptoms may occur:

Pain that worsens at night, especially when lying on the affected shoulder
Increased pain after keeping the shoulder still for a while
Discomfort when lying on the shoulder
Stiffness in the affected shoulder
Pain that gets worse with movement of the affected shoulder
Pain when pressure is applied to the area, such as when lying down
Swelling and redness

It's important to note that if you experience a fever along with these symptoms, it may indicate an infected bursa. In such cases, it is recommended to consult with a doctor for further evaluation and treatment.

Diagnosis

To diagnose shoulder bursitis, doctors commonly perform the following examinations, tests, and procedures:

Physical examination: The doctor will assess the location of pain, muscle strength, and range of movement in the shoulder joint.
Radiography (X-ray): This test helps rule out bone damage or arthritis as possible causes of shoulder pain.
Magnetic resonance imaging (MRI) scan: It can show inflammation in the bursa or any damage to the bone and surrounding tissue.
Fluid testing (aspiration): Fluid from the bursa can be taken and tested to rule out infection.

Additional examinations, tests, and procedures to determine the stage or severity of shoulder bursitis may include:

Functional testing: These tests are used to assess how well the shoulder moves and reacts under certain conditions. These include:
- Speeds test: Checks for tendon instability or inflammation (tendinitis) in the biceps brachii, a muscle in the upper arm
- Lift-off test: Evaluates for a tear or damage (tendinopathy) in the subscapularis, a muscle in the shoulder
- Jobes test: Tests for a tear or tendinopathy in the supraspinatus, a muscle in the shoulder that helps lift the arm
- Drop arm sign test: Assesses for a tear or tendinopathy in the infraspinatus, another shoulder muscle important for rotation
- Neers test: Determines subacromial impingement syndrome, which occurs when a tendon in the shoulder rubs or gets pinched under the shoulder blade
Musculoskeletal ultrasonography: This imaging technique shows detailed pictures of muscles and joints, looking for signs of inflammation, partial tears, damage, or fluid buildup in the shoulder joint and the rotator cuff.

Remember, these examinations, tests, and procedures should be performed by a healthcare professional. They will help diagnose and determine the severity of shoulder bursitis accurately.

Treatment Options

The goals of treatment for shoulder bursitis are to reduce pain, inflammation, and swelling, as well as to improve shoulder function. The following treatments can help achieve these goals:

Medications:
Anti-inflammatories: Over-the-counter medications like aspirin or ibuprofen can reduce swelling and discomfort in the shoulder. Ask your doctor about the appropriate dosing for your individual situation.
Steroid injections: If symptoms persist, a doctor may inject corticosteroids in or around the bursa to reduce swelling and discomfort. This treatment may be repeated several times.
Therapeutic procedures:
Surgery: In rare cases when other treatments are ineffective, surgery may be recommended to repair damage and reduce pressure in the bursa. This is typically considered after 6 to 12 months of unsuccessful treatment.
Health behavior changes:
Rest: Giving your shoulder enough time to rest can help reduce symptoms. Avoid activities that worsen symptoms and consider using a shoulder brace for support.
Ice packs: Applying ice packs for 15 to 20 minutes at 4 to 6-hour intervals within the first 5 days can help reduce pain and swelling.
Warming up and stretching the shoulder before exercising or repetitive use can help prevent bursitis.
Strengthening the shoulder muscles through gentle exercises can improve shoulder stability.
Improving posture can reduce joint pressure and keep shoulder muscles active.

Remember, it's important to consult with your healthcare professional for personalized advice and treatment options.

Medication type and dosing are affected by many factors and may vary by individual, and additional side effects may occur. Consult your healthcare provider for personalized advice and read the information provided with your medication. Surgery should only be considered if non-surgical options have been unsuccessful.