Shoulder (Subacromial) Bursitis
A bursa is a sac of synovial fluid, rich in protein and collagen, that acts as a cushion to protect soft tissue, such as tendons, ligaments and muscle, from friction and excess pressure. We have over 150 bursae (plural for bursa) in our bodies with most of them located in our joints.
Bursitis, by definition, is the inflammation or irritation of a bursa sac. When the bursa becomes swollen, the sac itself can develop little tears and may cause tears to the surrounding soft tissue. In some cases, the inflamed bursa also becomes infected with bacteria (referred to as septic bursitis) and it is necessary to see a doctor to get rid of the infection.
There are 3 main bursae around the rotator cuff. The subacromial bursa protects the supraspinatus tendon from the coracoid process and acromion. The subcoracoid bursa lies between the coracoid process and the joint capsule. The subdeltoid bursa lies under the deltoid muscle, cushioning it from the bones in the shoulder joint capsule. Often the subdeltoid and subacromial bursa are connected around the rotator cuff.
The subacromial bursa is the bursa in the shoulder that is most commonly affected by bursitis. It acts as a cushion to allow the supraspinatus tendon to slide smoothly over the neighboring soft tissue and bone. Due to its location and relationship to the acromion and supraspinatus, the subacromial bursa tends to be most at risk of being impinged or irritated.
Shoulder bursitis is often connected to impingement syndrome and rotator cuff tendonitis. For this reason, it is always wise to address and treat shoulder pain as soon as possible so that the problem doesn't get worse. A healthy subacromial bursa is usually about the size of a small plum, but can swell to the size of an orange when bursitis sets in. This is what creates the soft tissue damage or possible impingement in the shoulder joint.
The most common symptom is experiencing pain when lifting overhead. This is because the head of the humerus is compressing the swollen bursa against the glenohumeral joint and the underside of the acromion. If you have pain when lifting over head, however, it could indicate one or more soft tissue injuries in the shoulder. Subacromial bursitis is very often diagnosed alongside other rotator cuff problems or impingement syndrome.
Subacromial Bursitis - Who is at Risk?
If you are suffering or have suffered from other shoulder problems such as rotator cuff tendonitis, bone spurs, a hooked acromion, and/or impingement syndrome your subacromial bursa is at risk of becoming inflamed. These conditions can irritate the bursa which will result in bursitis if left untreated.
Repetitive overhead shoulder movements, especially if they are weight bearing, may cause fatigue or general weakness in the shoulder muscles and tendons. As a result, your shoulder joint could become misaligned causing more pressure on the subacromial bursa.
Calcification of the bursa sac can also cause inflammation from within the bursa.
Symptoms of Subacromial Bursitis
If you are suffering from inflammation of the subacromial bursa, you may be experiencing the following symptoms:
- Pain when lifting overhead or other movements in the shoulder.
- Noticeable tenderness and /or heat when the outer shoulder area and/or upper arm is touched.
- Pain that makes it difficult sleeping at night, especially while lying on the affected shoulder.
- Possibly a fever if you are suffering from septic bursitis (You will need to see a doctor for medication to get rid of the infection).
- Direct pressure on the bursa will exacerbate the pain and should be avoided if possible.
- Weakness and/or swelling in the shoulder and/or top of the arm can develop as the pain worsens and the inflammation in the area spreads.
It is important to treat bursitis in the early stages to reduce the symptoms, minimize damage and maintain motion and strength in your arm and shoulder. Resting your shoulder and reducing any activities that add pressure on your bursa will help to reduce your pain and bursitis inflammation. By treating your rotator cuff bursitis in the early stages with Cold Compression Therapy and Blood Flow Stimulation Therapy™, you are more likely to prevent long-term damage and chronic conditions from setting in.
Test for Subacromial Bursitis
Visiting your doctor when you have shoulder pain is always recommended, as there are many possible issues that can happen within the shoulder. Sometimes, one set of symptoms can result in multiple diagnoses. An X-Ray and MRI are often needed in order to diagnose a shoulder ailment properly.
Although rare, subacromial bursitis can be caused by an infection which is potentially serious. Your doctor will be able to rule this out as a possible cause.
You doctor will likely do some range of motion tests with you, and may refer you on to a physical therapist. Many people see great improvements in physical therapy with shoulder related problems and are able to treat the problem with conservative measures.
A sign that you may have subacromial bursitis is acute pain when trying to reach the affected arm behind you towards the lower back, as if to get something out of your back pocket. You would also experience pain when reaching above your head, as you would when putting something on a high shelf. If you feel sharp pain with both of these motions you may have shoulder bursitis and/or other related conditions and should see a doctor.
Bursitis Treatments - What You Can Do!
Relieving the symptoms of bursitis initially focuses on keeping the pressure off the bursa (i.e. carrying a backpack or purse on the opposite shoulder). Surgery may be required if your bursa irritation is a result of a bone formation problem, such as a hooked acromion causing impingement of the bursa. If your bursitis is caused by an infection (septic bursitis), the doctor will probably drain the bursa sac with a needle and perscribe antibiotics to treat the infection.
For non-infectious bursitis, the preliminary treatment starts with non-operative options such as rest and cold compression therapy to reduce swelling and inflammation. Surgery to remove the inflamed bursa is normally not required for bursitis, however if you fail to see improvement with the conservative treatments, your physician may recommend surgery to remove the bursa completely. Although this removes the problem of an inflamed bursa, you are left with less cushioning in your rotator cuff which can lead to a host of other shoulder pain and problems.
The most important factor in healing bursitis is resting your shoulder. This can be difficult when you have to carry on with daily activities, but resting your shoulder whenever you can is recommended. During your recovery you will probably have to modify or avoid the activities that stress your bursa until your pain and inflammation settle.
Treatments should involve decreasing swelling, relieving stress on the shoulder, correcting any biomechanical dysfunction (hooked acromion, bone spur, etc.), treating scar tissue, and then restoring strength and movement in your shoulder.
Cold Compression Therapy
To decrease inflammation and relieve the pain of rotator cuff bursitis doctor's recommend cold therapy.
Applying cold to your inflamed bursa will help decrease the swelling and redness around it. Cold therapy will also help to numb the pain in your shoulder and rotator cuff and help to control the inflammation.
Cooling your inflamed subacromial bursa as needed throughout the day, for approximately 15 - 20 minutes at a time, is recommended. Do not apply ice directly on your skin, rather wrap it in a cloth or towel or, better yet, use a cold wrap that fits easily and comfortably to your body.
The Shoulder Freezie Wrap® can be used to apply cold in a safe, convenient and effective way - and the gel pack is reusable. The gel pack sits gently over the inflamed subacromial bursa to reduce swelling and redness.
The wrap is soft and adjustable so it fits your shoulder properly, without irritating the bursa, and allows you to adjust the compression. This is important when treating an inflamed bursa because too much pressure can cause you further pain. You control how much pressure the bursa receives so you can benefit from the compression to hold the cold where you need it, without increasing your pain.
Applying cold to your tender bursa and rotator cuff is the first step in treating your bursitis. Then begin BFST® treatments through use of the Inferno Wrap® to continue the healing process.
Blood Flow Stimulation Therapy
Once the inflammation of your bursitis has been reduced with cold therapy it is time to improve blood flow and improve the elasticity of your surrounding soft tissue. Your body needs a fresh supply of blood to improve the health of your tissue and get your subacromial bursae and supraspinatus tendon back to normal.
Unfortunately, when you are suffering from bursitis in your subacromial bursa it is painful to lift your arm and use you shoulder. When you limit movement in your shoulder the blood flow is reduced, starving your tissue of the necessary oxygen and nutrients. The trick is to find a way to increase blood flow without causing pain and/or further inflaming the bursae. This is where Blood Flow Stimulation Therapy (BFST®) becomes a powerful tool.
BFST® compliments your body's natural healing process by promoting the flow of blood to your shoulder while you give it the rest it needs.
The Shoulder Inferno Wrap® uses a patented process to generate the same energy that is part of the sun's spectrum of light, the same energy that is necessary to all living things for optimum health. The energy emitted from the Energy Web® stimulates blood flow to your rotator cuff, more than your body would ever be able to generate on it's own, giving your body the boost it needs to continue the reconditioning process. The healing energy reaches deep into your subacromial bursa and supraspinatus tendon to speed tissue repair, whisk away the toxins and dead cells, and rejuvenate your rotator cuff tissues for improved elasticity.
Click here to learn more about how BFST® and Inferno Wraps® work.
With these simple and safe home treatment therapies - Freezie Wrap® cold compression therapy and BFST® therapy, you will notice significantly reduced pain and an significant improvement in the healing speed of your injured bursae.
We recommend that you consult your doctor and/or physiotherapist before using any of our outstanding products, to make sure they're right for you and your condition.
Pain and Anti-inflammatory
(NSAIDs - Non-steroidal anti-inflammatory drugs) can be used if required to help manage your pain. However, these aren't recommended for long term use, as they can cause gastrointestinal difficulties and increase the risk of cardiovascular disease. The use of cold therapy and BFST® in conjunction with NSAIDs can greatly improve the effect of this medication and can help to heal quicker.
Your doctor may aspirate the inflamed bursa. This involves removing the extra fluid that has built up with a needle. Sometimes, the fluid will be tested at a laboratory to rule out infection.
If your bursitis does not get better with conservative treatments, a subacromial decompression may be done. It is an arthroscopic procedure, so tine incisions are made and a pencil-sized camera is inserted into the shoulder. A small shaver is inserted into another incision, and is used to remove the swollen bursa all together. The surgeon will then look for any damage to the rotator cuff. If the subacromial space is small, the surgeon may use a burr to shave the acromion down in order to create more space for the rotator cuff tendons. This is also done to remove any bone spurs in the shoulder.
Recovery time for the surgery will depend a number of different factors including your healing ability, diet, rest and how many procedures were done in your surgery. Your doctor will advise you on your recovery, and will let you know if/when physical therapy can be started.