Physio Penrith Shoulder Bursitis Treatment
Treatment of Shoulder Bursitis at Sydney Muscle & Joint Physio Penrith
What is shoulder bursitis?
Bursae are synovial-line sacs overlying areas where structures, moving against each other, cause friction. The subacromial and subdeltoid bursa are fluid-filled sacs that serve to lubricate the shoulder joints, which surfaces are exposed to higher degrees of wear and friction. The subacromial bursa is bordered superiorly by the acromion, coracoid, coracoacromial (CA) ligament and the proximal deltoid muscle fibres and inferiorly by the fibres of the supraspinatus muscle. The subacromial-subdeltoid bursa—an extra-articular synovial space—lies between the rotator cuff tendons and the undersurface of the acromion, the acromioclavicular joint and the deltoid muscle, overlying the bicipital groove. The height of the subacromial space ranges from approximately 1.0 to 1.5 cm. Inflammation of the bursa can occur due to a variety of reasons leading to the development of subacromial bursitis.
What are the symptoms of shoulder bursitis?
Shoulder bursitis can be subdivide into three phases: acute, chronic and recurrent. The acute phase is marked by local inflammation with thickened synovial fluid. This condition results in painful movement, particularly with overhead activities as the bursa undergoes friction between the humeral head/supraspinatus inferiorly and acromion/deltoid superiorly. Chronic bursitis leads to the development of constant pain due to a chronic inflammatory process occurring in the bursa, which can also lead to weakness and eventual rupture of the surrounding ligaments and tendons. In cases of chronic bursitis, attention must be paid to the tendinopathy since these entities can be present simultaneously. Recurring bursitis can occur in patients exposed to repetitive trauma or routine overhead activities.
Shoulder bursitis usually presents with shoulder pain in the anterolateral aspect of the shoulder. Patients usually report a history of repetitive overhead activities such as overhead sports, overhead movements at work or at home and lifting boxes. In some instances there may a sustaining trauma such as a fall with direct impact to the shoulder. Patients will get increased shoulder pain when raising the arm up from the side of the body- causing the shoulder bursitis to impingement in the subacromial space.
How is shoulder bursitis diagnosed?
Our shoulder pain physio approach related to shoulder bursitis focuses first on a diagnosis and secondly on the impairments related to the condition. On physical exam, the patient will have point tenderness at the anterolateral aspect of the shoulder below the acromion. The pain is localised and does not typically radiate to other parts of the shoulder or the arm (if the pain does radiate, one must include cervical spine pathology in the differential). Pain is also elicited on resisted abduction of the arm beyond 75 to 80 degrees since during this arc of motion the subacromial bursa is compressed at the undersurface of the acromion.
It is important to remember that shoulder bursitis is often accompanied by other conditons that cause shoulder pain and bursal effusion:
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acromioclavicular joint arthritis - 70.4 % of individuals will have shoulder pain and bursal effusion
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supraspinatus calcific tendinopathy - 67.8 % of individuals will have shoulder pain and bursal effusion
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full-thickness tear of supraspinatus - 96.7 % of individuals will have shoulder pain and bursal effusion
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superficial tear of supraspinatus - 70.6 % of individuals will have shoulder pain and bursal effusion
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deep tear of supraspinatus - 65.6 % of individuals will have shoulder pain and bursal effusion
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partial tear of supraspinatus - 72.7 % of individuals will have shoulder pain and bursal effusion
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calcium-related bursitis - 100 % of individuals will have shoulder pain and bursal effusion
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trauma - 95.6 % of individuals will have shoulder pain and bursal effusion
Physio for shoulder bursitis treatment
At Sydney Muscle & Joint Clinic our physio for shoulder bursitis incorporates the best research supported non-surgical shoulder physiotherapy treatment options for shoulder bursitis include:
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Non-steroidal anti-inflammatory medications (NSAIDs)
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Physical therapy
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Corticosteroid injections
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Ultrasound therapy has also been utilised, although literature does not demonstrate it to be efficacious
Our shoulder pain physio treatment approach focuses on first settling the irritable shoulder pain down and then using specific exercises that target shoulder bursitis impingement in the subacromial space. Our physio for shoulder bursitis exercises to increase subacrmial space include:
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Increasing glenohumeral (shoulder) adduction forces
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Strengthening muscles that provide scapula retraction, upward rotation, & posterior tilt
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Increase the strength of the serratus anterior
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Thoracic mobility movements that target thoracic extension
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Strengthening all the rotator cuff muscles at the one time