Subacromial (Shoulder) Bursitis

Often you can't cleanly, and you don't need to. The two share the same space at the top of the shoulder, and bursitis commonly occurs alongside shoulder impingement ⁹. Both hurt as the arm goes up. What changes the plan is what else is involved: an irritated rotator cuff tendon, the biceps tendon, or a shoulder that's become stiff rather than just sore ⁶. If your main problem is that the shoulder won't move where you send it, Frozen Shoulder is the closer match.

Bursitis is usually diagnosed with a physical examination, sometimes with an X-ray or ultrasound ¹. The assessment matters more than the label, because it shows which movements to work on.

Most of the diagnosis happens in the examination. We press on different parts of your shoulder to find where it's tender, ask you to move your arm in several directions and test your arm strength. We may check your neck as well, in case the pain is coming from a pinched nerve there ⁶.

Scans are an extra. An X-ray doesn't show soft tissue like the bursa and is usually normal, so its job is to look for other possible causes ^{1 6}. An ultrasound or MRI can show fluid or inflammation in the bursa ⁶. If infection or another condition is suspected, a doctor may take a sample of the fluid or order a blood test ¹.

The aim is to settle the pain first, then rebuild your shoulder's capacity so it copes with the load that flared it ².

Shoulder bursitis is treated in the order set out in The Well Motion Recovery Path™. What your shoulder tolerates decides when you step up a phase. The calendar doesn't.

• Reset: while the shoulder is sore at night and sharp overhead. Ice and a break from overhead lifting ^1,2, pendulum swings and gentle range of motion ¹⁰, with manual therapy or taping if they make moving easier. Expect night pain to be the slowest thing to ease. We move you on once everyday reaching no longer leaves the pain building.
• Rebuild: the longest phase. Rotator cuff strengthening, shoulder-blade control, posture work and stretching ^2,6, progressed through Exercise Prescription & Conditioning. We move you on when the shoulder does what your daily tasks ask of it.
• Return: back to whatever flared it: overhead work, swimming, tennis, or sleeping on that side. We test the movements your job or sport demands. You leave with a strengthening and stretching program, which is recommended to reduce the chance of bursitis recurring ¹.

How long it usually takes. No study we found gives a healing time for bursitis on its own. In one trial of 77 people with a closely related shoulder tendon problem, pain, strength and function had improved by week 4 of a rehabilitation program lasting 12 weeks ¹¹. That trial is small, dates from 2011 and had no untreated group, so read it as a guide, not a deadline.

Prevention hasn't been trialled for shoulder bursitis on its own. The closest evidence comes from workers and overhead athletes with shoulder problems in general:

• Cut down the time your arms spend up. Pooled studies covering more than two million workers found that working with the arms raised, or under heavy shoulder load, roughly doubled the risk of a soft tissue shoulder disorder ⁷. Painting and construction are typical jobs, and swimming and tennis the typical sports ⁶. Avoid the activity that set it off, or change how you do it ¹.
• Break up repetitive tasks. Take breaks and stretch often when a job has you repeating the same movement ¹.
• Keep the shoulder strong. Strengthening the muscles around the joint, along with stretching, is recommended to reduce the chance of bursitis recurring ¹. In a trial of 660 elite handball players, a warm-up programme of shoulder strength and mobility exercises lowered the risk of shoulder problems by 28% over a season ⁸. Your physio can show you which exercises suit your shoulder.