Bursitis of the shoulder is one of the most common causes of acute shoulder pain. The bursa serves as an important cushion in the shoulder joint between the hard bone of the acromion and the tendons of the rotator cuff. If this cushion is irritated by overuse, calcifications (calcific tendinitis), or a narrowing of the space, it can become painfully inflamed. Such acute shoulder bursitis often makes it nearly impossible to move the arm. Whether the condition is acute or has already become chronic, a precise diagnosis and proper treatment of bursitis are crucial for restoring shoulder mobility and preventing long-term symptoms.
What are bursae, and what is their function?
Bursae (medical term: bursa) play an important role in protecting our joints and ensuring their mobility. These cushion-like structures, filled with a gel-like tissue fluid—hence the name “bursa”—are components of our joints and prevent damage caused by pressure. Consequently, bursae ensure that the joint can move without friction and remains supple.
Where are bursae found in the body?
Bursae are found wherever there is increased pressure, such as just beneath the skin over the kneecap or at the elbow. These bursae are visible from the outside when they become inflamed or swollen. However, there are also deeper bursae, such as those located beneath bones and within joint structures. These are necessary wherever hard structures come into contact with soft ones and rub against each other during movement.
This is the case, for example, in the shoulder joint. Here, the so-called long tendon of the biceps muscle—the flexor muscle on the front of the upper arm—runs through the joint and attaches to the edge of the shoulder blade. This tendon can also tear (known as a biceps tendon rupture), which leads to weakness in arm flexion. However, there is also a short tendon of this muscle that does not pass through the joint and thus maintains the flexion function.
A bursa in the shoulder joint, medically known as the subacromial bursa, protects the bones and tendons from overuse or tearing.
All joints in the body are protected by bursae. © freshidea / Fotolia
What are the symptoms of bursitis in the shoulder area?
Bursae can become inflamed, a condition known as bursitis. In subacromial bursitis—that is, inflammation of the bursa in the shoulder joint—typical signs of inflammation are present:
- The surface of the shoulder joint is slightly to noticeably swollen.
- It is painful when pressed.
- The skin is usually reddened and feels warm to the touch.
Due to the swelling of the bursa, the tendon’s range of motion is severely restricted. As a result, even the slightest movement of the arm often causes severe pain.
The shoulder joint is constantly under strain and is therefore susceptible © bilderzwerg / Fotolia
What causes subacromial bursitis?
Bursitis in the shoulder area is most commonly caused by overuse of the shoulder joint. It is usually due to prolonged exposure to an unusual source of irritation. During certain activities, the joint performs the same arm movement countless times—for example, when painting a wall or carrying furniture during a move. As a result, tendons and bones repeatedly glide along the protective bursal cushions.
This constant friction irritates the surface of the bursa. This often results in acute inflammation. If the strain continues, it can develop into chronic bursitis, which can last for weeks or even months.
Furthermore,
- a shoulder contusion,
- a blow, or
- a fall
can also cause subacromial bursitis. In rare cases, a bacterial infection may be responsible for bursitis in the shoulder area. This is observed more frequently following joint aspirations or arthroscopy, which is why these procedures should only be performed when absolutely necessary.
Bursitis in the shoulder usually occurs in middle-aged individuals. Certain underlying conditions such as
- rheumatism,
- arthritis, or
- gout
increase the risk of developing bursitis.
How is bursitis treated?
Uncomplicated bursitis in the shoulder usually heals on its own within a few days without requiring any special measures or medication. Simply resting and taking the weight off the shoulder joint is enough to resolve the condition.
If you continue to strain the shoulder joint despite the existing inflammation, the inflammation will likely not improve. There is then a risk that the bursitis will become chronic.
However, immobilizing the shoulder joint with a sling is now often discouraged, as this can cause the joint capsule to shrink (especially if used for more than 3 days). This, in turn, poses a risk of joint stiffness and should be avoided at all costs.
What else can help with more severe symptoms besides rest?
As a first step, it is recommended to cool the shoulder with ice. Cooling counteracts swelling and relieves symptoms. However, never place the ice pack directly on the skin—otherwise, there is a risk of frostbite. Cooling gels and ointments from the pharmacy are also effective.
Heat worsens the symptoms and often leads to a deterioration in the condition. You should therefore avoid mud treatments, saunas, or hot baths whenever possible.
Pain relievers such as acetaminophen can help with pain. Initially, it’s best to rest the affected area until the initial pain subsides.
Cooling, pain relief, and rest: first aid for bursitis © Microgen | AdobeStock
After a few days, the pain and the inflammatory process usually subside gradually. Then it’s time to carefully mobilize the shoulder again with special exercises. This is because joints stiffen more quickly than expected if they remain inactive for too long.
To do this, grasp the affected arm and move it upward, outward, and toward the center of your body in three separate exercise sets. Perform the movement so that you reach your pain threshold but do not go beyond it. Hold this position for a few seconds.
Repeat each exercise set 5 to 10 times several times a day.
When is it essential to see a doctor?
If there is no significant improvement in your symptoms after 4–5 days of resting the affected arm, you should have your shoulder examined by a doctor. This also applies to conditions following a fall, open wounds, and pus discharge, as well as fever and chills.
What tests are performed for bursitis?
In addition to a detailed review of your medical history (anamnesis) and an examination of the shoulder, a clear diagnosis can usually be made. An ultrasound examination and an X-ray may be ordered.
Especially if you fell onto your shoulder, these tests are intended to rule out or confirm an injury to joint and bone structures. An MRI scan may also be necessary if abnormalities are detected on the ultrasound or X-ray.
It is also important to distinguish bursitis from other possible conditions. Osteoarthritis, rheumatism, and gout can all present with similar symptoms. If the results are inconclusive, blood and urine tests may also be ordered, though this is very rare.
What treatment do doctors usually prescribe?
Treatment often begins with a prescription for anti-inflammatory medications designed to curb the inflammatory process in the shoulder.
Another treatment option is cortisone injections, which usually relieve symptoms very quickly. This pain-relieving and anti-inflammatory medication is injected directly into the shoulder joint or the bursa. This often leads to rapid improvement in symptoms. However, cortisone injections should only be used in very rare cases. The injection (medically known as a puncture) always carries the risk that pathogens (bacteria) could be introduced into the joint cavity, thereby worsening the condition.
In rare cases, extensive fluid collections may form in the bursa as a result of inflammation. These lead to swelling that is easily palpable. If these do not resolve on their own during the healing process, however, a puncture may be necessary and can be both appropriate and helpful. During the aspiration, the fluid accumulation is drained using a thin needle, causing the swelling to subside rapidly and the symptoms to resolve very quickly.
Once the inflammatory process has subsided, physical therapy is recommended to quickly restore full range of motion to the shoulder joint.
When is surgery necessary for shoulder bursitis?
Sometimes, bursitis can persist for 3–6 weeks despite medical treatment. In such cases, surgery is considered. Bacterial bursitis or open wounds—and the resulting externally visible bursa—may also sometimes require surgery.
During surgery, part of the bursa and, if necessary, the surface of the bone are smoothed. The procedure is performed as open surgery (via an incision in the skin) or minimally invasively using the so-called keyhole technique. With minimally invasive surgery, the healing process is usually much faster, and only small incisions are needed to access the joint cavity.
How can you prevent (recurrent) bursitis?
In principle, the same applies here: prevention is better than treatment. You can effectively prevent overuse of the shoulder joint on your own. A new activity or hobby often involves new movement patterns that the body is not used to.
In sports like tennis or rowing, we perform the same movement over and over again for hours on end. If these repetitive movements are unfamiliar to us, they place an enormous strain on the shoulder joints.
In such cases, it’s advisable not to overexert the joints. If possible, take a few-minute break every so often. This is the only way your body has a chance to slowly get used to new movement patterns and withstand the strain without injury.
Regular recreational exercise that keeps the joints in good condition also reduces the risk of developing bursitis.
People who are not very active in their daily lives are most susceptible to bursitis. Stiff, immobile joints become inflamed particularly quickly when subjected to new, unfamiliar stresses.
But when it comes to exercise, the same rule applies: moderation is key, because both too much (overuse) and too little (inactivity) can be harmful and lead to disorders of the joints and the entire musculoskeletal system. So: don’t overdo it, and take good care of yourself.
FAQ: The 8 Most Important Questions About Bursitis of the Shoulder
What are the typical symptoms of shoulder bursitis?
The main symptom is sudden, severe pain in the shoulder, especially when raising the arm out to the side. Those affected often report swelling and warmth in the shoulder area. Since the inflamed bursa becomes pinched under the acromion, mobility is severely restricted. In addition, pain often occurs at rest during the night when lying on the affected shoulder. Other symptoms may include pain radiating into the upper arm.
What causes shoulder bursitis?
The cause of bursitis is usually mechanical overuse. Constant overhead work or athletic activity repeatedly irritates and compresses the bursa between the head of the humerus and the acromion. Calcific tendinitis, in which calcium deposits in the tendons narrow the space, or bony changes in the acromion (impingement) can also contribute to bursitis. Less commonly, a bacterial infection—such as one resulting from an injection—can be the trigger.
How is bursitis in the shoulder joint diagnosed?
If bursitis is suspected, the doctor first takes a medical history and performs a physical examination. To confirm the diagnosis and rule out other causes, such as a rotator cuff tear, an ultrasound examination is standard. In cases of unclear findings or chronic symptoms, magnetic resonance imaging (MRI) provides precise images of the soft tissues and shows the extent of inflammation in the shoulder’s bursa.
What is the treatment for bursitis?
Treatment aims to reduce inflammation and relieve pain. During the acute phase, rest and cooling are the primary focus. Anti-inflammatory medications (such as ibuprofen) or a targeted cortisone injection into the bursa can help speed up the resolution of symptoms. Once the acute pain subsides, physical therapy helps strengthen the muscles and stabilize the joint.
When is bursitis treated surgically?
Surgery is usually considered only if conservative treatment fails to bring about improvement over several weeks to months, or if the bursitis is chronic and keeps recurring. During the surgery, which is usually minimally invasive (arthroscopic), the inflamed bursa is removed and, if necessary, the acromion is widened to create more space for the tendons.
What is the difference between acute and chronic bursitis?
Acute shoulder bursitis occurs suddenly, often after an unusual strain, and is accompanied by severe pain. Once the irritation has subsided, it often heals without any lasting effects. Chronic bursitis, on the other hand, develops over a longer period of time, often due to persistent impingement syndromes. The symptoms vary in intensity—sometimes more severe, sometimes less—but never disappear completely and can lead to permanent limitations in movement.
How can you prevent bursitis of the shoulder?
The best way to prevent bursitis is to avoid one-sided overuse, especially when working overhead. Targeted exercises to strengthen the rotator cuff help center the humeral head within the joint, thereby relieving pressure on the bursa. Good posture and avoiding slumped shoulders can also help prevent irritation of the structures in the shoulder.
How long does shoulder bursitis last?
The course of the condition varies from person to person. Uncomplicated acute bursitis can heal within two to three weeks with consistent rest. However, if it is chronic bursitis or if there are contributing factors such as calcific tendinitis, the condition may persist for several months until the inflammation has completely subsided and full range of motion in the shoulder has been restored.
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About the medical author
Prof. Dr. med. Susanne Regus
Prof. Dr. med. Susanne Regus – medical author: expert articles, professional insights and medical expertise in the Leading Medicine Guide.
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