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Shoulder Bursitis Physiotherapy



Shoulder bursitis is a reaaaaaally common cause of shoulder pain, and we do treat a lot shoulder pain cases in our Phoenix physio clinics..

It happens when one of the bursa in our shoulder joint, which is a small fluid-filled sac, gets irritated and inflamed.

There are a number of different bursa (pleural bursae) around the shoulder that may be affected, but the most common is the subacromial bursitis.

This subacromial bursitis will lead to shoulder pains which tends to develop gradually over time and may decrease shoulder movements where you lift your arm above your head or behind your neck or back.

When treated promptly and effectively with shoulder physiotherapy, symptoms of subacromial bursitis will usually resolve within a few weeks, but if ignored and left untreated, symptoms gradually get worse and worse and unfortunately may even cause secondary problems to develop.

first of all...What is Bursa?

A bursa is a smooth sac that contains synovial cells that produce lubricating fluid.  

There are more than 150 bursa located throughout your body which sit between muscles, tendons and/or bones! 

What they do is that they function to provide cushioning and a smooth surface allowing the tissues to glide freely and fully as you move without any friction. 

There are a number of bursae located around the shoulder joint as shown in the diagram including the:

  1. subacromial bursa
  2. subscapular bursa
  3. subcoracoid bursa
  4. coracoclavicular bursa  
  5. supraacromial bursa 
  6. subdeltoid bursa

Inflammation of any of these may cause pain.

The most common type of shoulder bursitis is subacromial bursitis which is often linked with shoulder impingement syndrome.

There are other bursa which is located around the shoulder blade which we will look at separately.  

Causes of Shoulder Bursitis

Whenever any of our joint bursa gets irritated or injured, it will respond by producing more synovial fluid in an attempt to protect itself and the surrounding tissues which leads to inflammation.  

This may be caused by:

1)  Repetitive Friction

Repeated overhead movements such as

  • racquet sports such as tennis or badminton
  • painters repeatedly working on painting a ceiling
  • sporting/hobbies such as baseball, cricket, swimming with a lot of throwing and overhead activities can cause repeated micro-trauma to the bursa.  

This is the most common cause of shoulder bursitis.

2) Direct Injury

A sudden injury such as a fall onto the shoulder, or falling/landing on an outstretched hand can lead to bleeding and inflammation of the bursa.

Sometimes we can get direct injuries or blows in contact sports like boxing or basketball too.

3)  Underlying Condition

Medical conditions such as

can cause bursitis shoulder.

4)  Surrounding Structures

If the space surrounding the bursa is reduced, such as the subacromial space, this leads to an increased pressure  placed on the bursa and it gradually irritates the bursa which over time becomes inflamed. 

This can happen as a result of

  • arthritis (small lumps of bone known as osteophytes protrude into the space surrounding the bursa)
  • poor posture (such as forward rounded shoulder position, common with people who work on computers all day)
  • any muscle imbalance (one group of muscles shorter/weaker than the other) or
  • inflammation of other surrounding structures 

Whilst inflammation can develop in any of the bursae around the shoulder, again, the most common is subacromial bursitis.

The subacromial bursa is the shock-absorbing cushion that lies between the rotator cuff tendons and the acromion, the front part of the shoulder blade that forms a sort of bridge over the tendons, in what is known as the subacromial space.

Every time you lift and move your arm up, your rotator cuff tendons are gliding through this space so anything which narrows the space leads to irritation in the bursa and the tendons themselves.  

Shoulder bursitis is seldom found in isolation as it "typically turns up" with other shoulder problems such as shoulder impingement or tendon tears – visit the shoulder impingement and rotator cuff tear for more info.

Shoulder Bursitis Symptoms

Shoulder bursitis can be vague to diagnose especially during the earlier stages because of the symptoms that can be a whole slew of other shoulder conditions.

We recommend you consider seeing our senior physiotherapists for a full shoulder assessment if you have any aches, pains or discomforts in your shoulder.

The symptoms of shoulder bursitis may vary from person to person but it typically include:

1) Shoulder Pain

In most cases, shoulder pain tends to gradually over time due to repeated friction over the shoulder bursa.

It tends to start off as a low level aching pain which gets more and more painful or worse with activities where your arm is raised over your head such as

  • swimming
  • golfing
  • cricket
  • baseball
  • basketball
  • lifting kids/children
  • etc

The pain is usually fairly localized (in one location) over the problem area but in many patients, over time, the localized pain may start to travel down the arm, usually not past the elbow.

Of course if the shoulder bursitis was caused by an acute or sports direct injury, the shoulder pain will more likely be instant and more severe.

It can be very, very painful when any pressure goes into and through the shoulder, making even seemingly basic things like

  • sleeping on your side
  • stretching
  • wearing long sleeve shirts, jackets, sweaters or cardigans

very uncomfortable.

Our patients with shoulder bursitis often report that their sleep is frequently interrupted due to the shoulder pain that tends to wake them up and keeps them from falling into deep sleep.

If your shoulder pain associated with shoulder impingement, you may experience a painful shoulder movement arc, where as you lift the arm up it starts to get painful, but once you have passed or reached a certain height, the pain suddenly disappears

The reason for this is how the pressure changes through the bursa as you move your arm – read more in the shoulder impingement section.

2) Shoulder Stiffness 

Patients often report that their shoulder joints and movements may become limited, particularly reaching over head or behind your back/neck, affecting activities such as

  • wearing long sleeve shirts, jackets or sweaters
  • wearing or taking off your bra
  • reaching for items on high shelf/places

becomes harder and painful as the condition progresses. 

This shoulder joint stiffness tends to develop secondary to pain - what happens is that it hurts to move the arm so you use it less, compensating with the non-painful arm.

Technically, this is "okay" in the short term, as patients with shoulder pain will need to protect the bursa from further damage, but if you continue to not use or decrease the use of your affected arm for the long term, what happens is that the soft tissues aren't getting moved and stretched as they should so they naturally start to tighten which further limits movement and creates and more pain. 

Shoulder physiotherapy is definitely one of the best ways to prevent and avoid this from happening, as well as to treat shoulder pains and tightness.

3) Shoulder Weakness

If your shoulder pain is causing you to favor your unaffected arm, unfortunately over time, the affected painful shoulder muscles may lose some strength.  

This will lead to other problems as the weakness leads to subtle changes to the way the shoulder and shoulder blade move which can lead to further irritation.

Strengthening exercises from our senior physical therapist helps to prevent and correct this.

4) Note For Any Signs of Infection

There are a small risk for septic bursitis, where there is an infection in the bursa, usually due to bacterial infection to happen, and it will result in you

  • feeling feverish and unwell with a high temperature and
  • you may feel that your shoulder is often red and warm. 

If you suspect you have a bursa or bursitic infection, you must see a doctor immediately as the infection will need to be treated with antibiotics (untreated infections can cause irreversible damages to the local structure within the shoulder).

Sometimes when bursa become inflamed, particularly with elbow or knee bursitis, it may get to a point where there is obvious swelling, like a small squashy orange, but this is uncommon in shoulder bursitis.

Shoulder Bursitis Treatment

Shoulder bursitis treatment goals are to

  • reduce pain and inflammation
  • prevent and correct any weakness and decreased movement at the shoulder
  • prevent secondary problems developing such as shoulder impingement
  • and get you back to your life, work, responsibilities

There are a number of different shoulder bursitis treatment options:

1) Ye Good 'Ol Rest 

It is important to identify and entirely avoid activities which aggravate your shoulder  pain and shoulder bursitis, such as overhead movements. This is mainly to give your inflamed bursa a chance to heal.  

If you keep ignoring your pain and pushing on into the pain, the friction over the bursa will keep continuing and the inflammation doesn’t get a chance to settle down and will gradually get worse.

2)  Cold Therapy

Applying cold therapy regularly to the shoulder can help to reduce pain and inflammation in the bursa.

It should be used for 10-15 minutes at a time, with at least two hours between applications.  

3) Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Your doctor may prescribe non-steroidal anti-inflammatory medication such as ibuprofen or Advil to help to reduce the pain and the swelling.

4)  Aspiration

In some cases, your doctor may even decide to drain fluid out of the bursa to help reduce the swelling, especially if they are worried about a growing infection.  

They will send the fluid off for testing to see if there is an infection which would require antibiotics.  

Typically any aspiration procedures is usually combined with a corticosteroid injection.

5)  Injections

Injections are one of the best ways to treat shoulder bursitis.

A mix of local anaesthetic and corticosteroid solution (H&L or K&L) are injected into the bursa to reduce pain and inflammation.

Ideally the injection should be done under diagnostic ultrasound guidance to ensure delivery to the correct area.

It is important to take it easy for the first few days following an injection and avoid heavy lifting.

6) Shoulder Physical Therapy

This is a very important and vital part of shoulder bursitis treatment, both to treat the condition and to prevent it from recurring.  

Our senior physiotherapists will work on shoulder rehab program with you to address any areas of

  • weakness
  • joint stiffness
  • shoulder joint instability
  • tightness
  • any postural problems

Our goal is to ensure you regain full movement and strength in the arm, and good stability around the shoulder blade all of which help to prevent the problem from recurring. 

Our senior physiotherapists may also apply the use of ultrasound therapy to help reduce inflammation and facilitate healing but the evidence is mixed.

7) Shoulder Surgery

It is very rare that shoulder bursitis requires surgery but if all other treatment options fail, the bursa can be surgically removed through keyhole surgery.

Patients may also receive the following shoulder physiotherapy treatment modalities:

Recovery & Prevention

People usually make a full recovery from shoulder bursitis but it may take a few weeks or months depending on the severity and any associated conditions.

Strengthening exercises, shoulder stability exercises focusing on the shoulder blade, and postural re-education are some of the best ways to reduce the friction going through the bursa thus preventing the condition from recurring.

Shoulder bursitis is often accompanied by other problems such as rotator cuff tears and shoulder impingement syndrome.



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book your physio appointment or enquire now

Email questions and your preferred physiotherapy timings to nigel@phoenixrehabgroup.com or

WhatsApp / SMS your name, preferred date, time and enquiries to +6588001830

Clinic Locations: See how to get to us here

Phoenix Rehab physio Services

Phoenix Rehab Group works with specialist physiotherapists and rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.



HAND THERAPY &  SPLINTING

Patients who sustained injuries to their elbows, forearms, hands, wrists (sprains and fractures) and fingers, and requires Hand Therapy to increase the function of their hand following injuries or post-operations as well as custom made hand splints.

Commonly treated hand pain injuries includes



CLINICAL PILATES & WELLNESS PILATES

Clinical Pilates is a form of physical exercise that focuses on

  • posture
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  • balance
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  • strength
  • flexibility and
  • breathing

It is a system of safe and effective exercises, which meet specific individual needs, to treat a wide range of injuries and conditions.

You may do Pilates as matwork or with the reformer or both, and every session will be customized 100% to your fitness, injury and tolerance.



TRADITIONAL CHINESE MEDICINE (TCM)



DEEP TISSUE RELEASE & SPORTS MASSAGE THERAPY

Sports and deep tissue release massage helps to increase nutrient-rich blood flow to tired, tight and tense muscles to

  • accelerate recovery and
  • shorten downtime / recovery period required

It also prevents muscles from scar tissue micro-tears (and potential ruptures), and increases muscle performance.

Done regularly, it will keeps your muscles healthy and fit with body/movement-confidence. Read the benefits of regular deep tissue release therapy here.



ALTERNATIVE THERAPIES

All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB).

See our entire team here with introductions and their specializations.

At the first session, our specialist physiotherapists will carry out a thorough assessment, helping them to select the most appropriate treatment to help you recover as well as provide treatment in the same session.

Follow up sessions are inline to provide expert treatment for your pain as well as prescribing specific exercises to reduce your risk of re-injury and giving you a long term solution.

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We do not rely on advertising - instead, we prefer and appreciate the goodwill and positive reinforcement from patients. When you have the chance, please tell your family, friends and physicians about the positive results and experience you have had in our physio clinics.

book your physio appointment or enquire now

Email questions and your preferred physiotherapy timings to nigel@phoenixrehabgroup.com or

WhatsApp / SMS your name, preferred date, time and enquiries to +6588001830

Clinic Locations: See how to get to us here