What is it?
There are 160 bursae in the body. They are a fluid filled sac which helps to reduce the friction between tissues of the body. The major bursae are located adjacent to the tendons near the large joints such as the shoulders, knees, hips and elbows.
The most common bursa to get inflamed in the shoulder is the Sub-acromial bursa. It sits in the space between the acromion (tip of the shoulder) and the rotator cuff. It allows the tendon to glide freely underneath the bone. When the bursa gets irritated it becomes inflamed and fills with more fluid, thus taking up more space in the shoulder.
How does a bursa become inflamed?
A bursa can become inflamed from injury such as a fall onto the shoulder or from repeated minor trauma such as overuse of the shoulder – repetitive reaching overhead, lifting etc. When the latter is the cause, it is often associated with impingement and tendonitis of the rotator cuff tendons. Impingement is where the bursa becomes impacted on the bone (acromion) as you lift your arm out to the side. The reason this occurs is the bursa is now larger and has no room to move freely so it protrudes out to the side under the acromion and gets ‘pinched’ between the bones.
What are the signs of Bursitis and Impingement?
- Pain can be gradual in onset over weeks or months.
- Pain is usually located on the outside of your shoulder but may spread down your upper arm as far as your elbow and less commonly the wrist.
- The pain can be made worse by using your arm above your head, driving a car, putting on your seat belt, washing your hair, putting your hand behind your back or lying on the affected shoulder.
- There can be a painful arc of movement – shoulder pain felt between 60-90 degrees of the arm moving up and out to the side.
- You often feel more comfortable with your arm in to and across your body.
How to diagnose Shoulder Bursitis
The Physiotherapists at Pro Physio SA are able to differentiate shoulder bursitis from a rotator cuff injury by using a variety of manual testing. As shoulder bursitis commonly co-exists with a rotator cuff tendinitis or tear, your physiotherapist will be able to determine this for you.
Ultrasound scans are also useful to diagnose sub-acromial bursitis, impingement, rotator cuff tendinitis or tears.
How to treat Bursitis/Impingement
Our Physiotherapists will provide you with a thorough biomechanical examination of your shoulder and scapula function to work out the cause of your bursitis and or impingement.
In the acute phase, our main goal is to reduce the inflammation of the bursa through rest from the pain provoking postures and movements. We can use a variety of pain relieving techniques such as electrotherapy, dry needling, manual therapy and shoulder taping to help settle your pain. This may be done in conjunction with anti-inflammatories prescribed by your GP.
In the mid to later stages we will work on improving your posture, scapula and rotator cuff strength through a targeted rehabilitation program. This will prevent your bursitis from returning.
If you feel that you may be suffering from bursitis or impingement, get in contact with one of our Physiotherapists. We will get you back on track and pain free.
Rebecca Gigney, Senior Physiotherapist