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Bursitis of the Shoulder

Bursitis of the shoulder is a common condition that results in pain, inflammation, and limited movement in the shoulder joint. This guide aims to provide an in-depth look at shoulder bursitis, its causes, symptoms, diagnostic procedures, and available treatment options. 

Whether you’re an athlete, someone who engages in repetitive shoulder movements, or someone experiencing sudden shoulder pain, understanding bursitis is the first step toward effective management and recovery.

What Is Shoulder Bursitis?

Bursitis of the shoulder is a painful medical condition characterized by inflammation of the bursae located in the shoulder joint. Bursae are small fluid-filled sacs that are situated between tendons, muscles, and bones. Their role is to reduce friction and allow muscles and tendons to move smoothly across bony surfaces within the joint.

There are four major bursae within the shoulder:

  • Subacromial
  • Subscapular
  • Subcoracoid
  • Subdeltoid

Types of Shoulder Bursitis

There are three major types of shoulder bursitis. These include:

  • Chronic bursitis: the most common, which typically occurs over time due to repetitive irritation of the bursae. 
  • Acute traumatic bursitis: due to trauma in which the bursae become irritated and inflamed. 
  • Infected bursitis: occurs when one or more of the shoulder bursae become infected.

Symptoms of Shoulder Bursitis

Symptoms of shoulder bursitis can vary depending upon a number of factors, including the severity of the bursitis. The most common symptoms include:

Shoulder and Arm Pain

Pain is the most common symptom. It can be located on the top, front, or back of the shoulder. Many patients complain of severe pain when lifting the arm to the side, pushing on or opening a door, or trying to “circle” the arm.

Reduced Range of Motion

An inflamed bursa can make overhead activities difficult and painful.

Swelling in the Shoulder Joint

Swelling around the shoulder joint is a common sign of bursitis. In severe cases, the swelling can be visible and may cause stiffness in the joint.

Common Causes of Shoulder Bursitis

Shoulder bursitis can affect anyone. It involves the inflammation of one or more shoulder bursae with resultant pain and restriction in range of motion. The most common causes of shoulder bursitis include: 

Shoulder Injury

Trauma or repetitive strain on the shoulder joint can cause irritation, inflammation, or damage to the bursae, leading to bursitis. Examples include falling onto the shoulder or being struck during athletic activities.

Infection

Infection can cause shoulder bursitis when bacteria, viruses, or fungi invade the bursae, leading to inflammation and possible infection. Infection can occur via direct entry, spread from nearby structures, or spread through the blood. 

Arthritis or Gout

Arthritis involves degeneration of the joint. As the cartilage wears down, there is increased friction and stress on the shoulder joint, including the bursae, which can become inflamed, creating shoulder bursitis. Joint stability and joint mechanics can be altered with arthritis making the shoulder joint susceptible to bursitis.

Tendonitis

Tendonitis is a common medical condition characterized by pain and inflammation of one or more tendons. Tendons are thick pieces of connective tissue that connect muscle to bone. Inflammation from the tendon along with altered biomechanics can lead to shoulder bursitis.

Diabetes

Diabetes is a serious medical condition characterized by elevated blood sugars due to inadequate insulin production or ineffective use of insulin by the body. Diabetes can lead to chronic inflammation, impaired immune function, and shoulder joint stiffness, making the shoulder susceptible to shoulder bursitis (1).

Thyroid Disease

Thyroid disease can cause a wide range of symptoms, including inflammation in the joints. This inflammation can increase the susceptibility to shoulder bursitis and other inflammatory conditions.

Bone Spurs

A bone spur is an abnormal bone growth, typically due to instability. Bone spurs in the shoulder can contribute to bursitis of the shoulder due to mechanical irritation and alteration in biomechanics. Bone spurs can impinge on, irritate, or damage structures in the shoulder, including the bursae, leading to bursitis.

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a medical condition characterized by shoulder stiffness, pain, and reduced range of motion. The altered biomechanics can lead to increased pressure and friction on the bursae, leading to shoulder bursitis.

Osteoarthritis

Osteoarthritis of the shoulder is a degenerative disease characterized by the breakdown of cartilage, bone spur formation, stiffness, and reduced range of motion. Alterations in the shoulder biomechanics and bone spurs can lead to bursitis in the shoulder. 

Rotator Cuff Tears

The rotator cuff is a group of four tendons that connect muscles to bones and help stabilize the shoulder joint. They are susceptible to injury and degeneration, which can lead to pain, restricted range of motion, and changes in biomechanics. This in turn can lead to bursitis of the shoulder.

Shoulder Impingement Syndrome/Swimmer’s Shoulder

Shoulder impingement syndrome is a painful medical condition that occurs when the rotator cuff tendons become compressed or irritated as they pass through the narrow space between the acromion and the upper arm bone (humerus). 

This compression can lead to pain, weakness, damage to the rotator cuff tendons, bone spur formation, and changes in the shoulder biomechanics. Collectively, these predispose the shoulder to bursitis. 

Common Treatments for Shoulder Bursitis

There are many different treatment options for shoulder bursitis. Which treatment option is best depends upon several factors, including the severity of the bursitis, the degree of restriction in range of motion, prior shoulder or neck surgeries, and access to healthcare. When appropriate, conservative care should always be first-line treatment. 

Treatments at Home

  • Temporarily stopping the shoulder-straining activity
  • Ice packs
  • Pain relievers
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Common examples include Ibuprofen, Naproxen, and Diclofenac, which are powerful anti-inflammatory agents that can reduce pain and inflammation. Unfortunately, there are significant side effects and, therefore, these medications should be avoided.

 Nonsurgical Treatments

When conservative at-home treatments fail to provide significant or sustained benefit, patients are often referred for additional treatments. The most common nonsurgical treatments include:

  • Bursa (steroid) injections: The bursa is a fluid-filled sac that limits friction as tendons and muscles travel across bony surfaces. Steroids can be injected into the bursa to reduce inflammation, pain, and restricted range of motion. Examples include Kenalog, Depo-Medrol, and Celestone. These medications have significant adverse side effects and do not address the underlying structural issues. 
  • Corticosteroids: Oral steroids are often prescribed to reduce pain and inflammation. 
  • Physical therapy exercises: Physical therapy has many different modalities that can reduce pain and inflammation associated with shoulder bursitis. Examples include heat, ice, ultrasound, electrical stimulation, soft tissue mobilization, and massage.
  • Antibiotics: Antibiotics are indicated when the bursitis is due to infection. 

Surgical Treatments

Surgery for shoulder bursitis is typically considered when conservative treatments such as rest, physical therapy, medications, and steroids have failed to provide significant and sustained benefit. Surgery may be indicated when full thickness, retracted rotator cuff tears, and large bone spurs are present. 

An arthroscopic bursectomy is a common, minimally invasive surgery in which a small camera is inserted into the shoulder joint and the inflamed bursae are removed. This is often performed in conjunction with subacromial decompression where inflamed tissue, bone spurs, and other obstructions are surgically removed. There is no high-level evidence to support this procedure and it can lead to shoulder instability and continued pain (2). 

How Shoulder Bursitis Is Diagnosed

The diagnosis of shoulder bursitis starts with a complete medical history and physical examination assessing shoulder strength, range of motion, and areas of pain. Diagnostic tests may include:

  • X-rays: To evaluate for arthritis or bone spurs.
  • Ultrasound: A powerful in-office imaging tool that can identify rotator cuff and bicep tendon injuries, effusions, arthritis, ligamental laxity, and structural instability. At the Centeno-Schultz Clinic ultrasound examinations are part of our new patients’ evaluation and follow-up evaluations.
  • MRI (magnetic resonance imaging) is a powerful imaging modality that uses powerful magnets and radiowaves to create 3D images of the body, including muscles, tendons, ligaments, cartilage, bone, nerves, and vascular structures. It does not use radiation and is available in most metropolitan centers. 
  • Blood tests: May be ordered if infection is suspected.
  • Aspiration: An in-office procedure where a small needle is used to remove fluid from the inflamed bursae to evaluate the presence of infection or gout. 

How Soon Should You Call Your Doctor?

You should contact your medical provider if you have:

  • Persistent pain, despite conservative treatment 
  • Compromised quality of life and function
  • Persistent restriction in range of motion 
  • Persistent shoulder weakness
  • Signs of infection such as fever, chills, or night sweats 
  • Shoulder redness and swelling that does not respond to conservative care

Ways to Prevent Bursitis in the Shoulder

Ways to reduce shoulder bursitis:

  • Do some shoulder stretching
  • Warm up the shoulder before doing activities
  • Wear a shoulder brace
  • Do some bursitis shoulder exercises

How We Can Help

Our approach at the Centeno-Schultz Clinic is fundamentally different than others, as we don’t simply treat the symptoms.

Rather, we dig deep to understand and identify the underlying problems that lead to the development of shoulder bursitis. It is important to understand whether the underlying cause is shoulder instability, rotator cuff injuries, bone spurs, or infection. Why? Because once the underlying cause is accurately identified, the best treatment plan can be designed. This in turn provides the best clinical outcomes.

Treatment options depend upon the underlying cause of shoulder bursitis and may include PRP and/or bone marrow-derived stem cells. Both are processed in a state-of-the-art cell laboratory, which allows us to customize both the platelet and bone marrow concentration for each patient. 

All injections are performed under X-ray or ultrasound guidance to ensure that the targeted areas are treated. Injections without guidance, otherwise known as blind injections, are below our standard of care and are not in the best interest of the patients. 

Bursitis of the shoulder is a painful medical condition characterized by inflammation of the bursae located in the shoulder joint. Bursae are fluid-filled sacs that reduce the friction between the muscles and tendons as they course across bony surfaces.

There are three major types of shoulder bursitis: acute, chronic, and infectious.

Symptoms of shoulder bursitis include pain, reduced range of motion, and swelling.

Common causes of shoulder bursitis include shoulder trauma, infection, arthritis, gout, tendonitis, diabetes, bone spurs, frozen shoulder, osteoarthritis, and rotator cuff tears.

Common treatments include conservative at-home therapy, physical therapy, and injected and oral steroids. Patients who fail to respond are often referred for surgery. Bursectomy (removal of the bursae) and subacromial decompression are common surgeries and may lead to continued pain and shoulder instability.

The diagnosis of bursitis of the shoulder requires a complete medical history and physical examination. Additional studies required may include X-rays, ultrasound, and MRI.

Shoulder bursitis associated with pain and restriction in range of motion is a warning sign that you have a medical problem that warrants evaluation. If left untreated, bursitis can lead to chronic pain, limited range of motion, and damage to the bursae including rupture, tendonitis, and possible rotator cuff tendons.

Treat the problem early and avoid complications. Schedule an in-office or telemedicine evaluation to learn about regenerative treatment options for shoulder bursitis.

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Thoracic Spine Physician and Expert

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate and PRP for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI).

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References:

  1. Struyf F, Mertens MG, Navarro-Ledesma S. Causes of Shoulder Dysfunction in Diabetic Patients: A Review of Literature. Int J Environ Res Public Health. 2022 May 20;19(10):6228. doi: 10.3390/ijerph19106228. PMID: 35627764; PMCID: PMC9140829.
  2. Beard DJ, Rees JL, Cook JA, Rombach I, Cooper C, Merritt N, Shirkey BA, Donovan JL, Gwilym S, Savulescu J, Moser J, Gray A, Jepson M, Tracey I, Judge A, Wartolowska K, Carr AJ; CSAW Study Group. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomized surgical trial. Lancet. 2018 Jan 27;391(10118):329-338. doi: 10.1016/S0140-6736(17)32457-1. Epub 2017 Nov 20. PMID: 29169668; PMCID: PMC5803129.

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