Of all the joints in the body, the shoulder is the most mobile. We interact with our surroundings using our hands, and in order to do that, we need our shoulders to be able to get the rest of the arm in many different positions. Whether it’s hanging up the washing, grabbing something from the back seat, or throwing a ball, the shoulder does a lot!
With all this mobility, however, comes a higher chance of the shoulder getting into some uncomfortable positions. Many patients who come to physiotherapy for shoulder concerns report a sharp, pinching sensation with overhead movements, or a decreased ability to reach behind their back. Sometimes, even lying on the affected shoulder can be painful and can result in a poor night’s sleep.
Sound familiar…..? You may have heard of shoulder bursitis.
What is shoulder bursitis?
A bursa is a small, slippery sac of fluid that functions as a cushion and reduces friction in the body. Tendons, ligaments, and muscles all glide over bones and other structures when we move, so bursa are strategically located in areas where there is significant movement… such as the shoulder!
Sometimes, if there is excessive movement of the shoulder (e.g., through work), the bursa can become irritated and inflamed, resulting in bursitis. This inflammation can be painful and also contribute to the pinching sensation during movements (especially above shoulder height) and pain when lying on the affected side.
Do I have shoulder bursitis?
Possibly! In order to diagnose shoulder bursitis, you need to know there’s inflammation of the bursa. This is usually done via an ultrasound or MRI scan.
Imaging isn’t a necessary part of solving your shoulder pain. That’s because what we see on scans doesn’t always tie in with what patients report as their symptoms (Park et al, 2020). People are much more than their scans. As such, we are moving away from using the label of shoulder bursitis and have found subacromial pain syndrome or rotator cuff-related shoulder pain to be more accurate terms. The former simply describes the location of the pain, and the latter refers to the common muscular deficits that can contribute to shoulder pain.
So how do I know if I have subacromial pain syndrome or rotator cuff problems?
If you’ve been having some shoulder pain as described above, we recommend seeing a physiotherapist for a thorough assessment. We will look at how much movement you have in your shoulder, take measures of your shoulder strength, and also screen other parts of the body like the neck and upper back to ensure that the problem isn’t coming from somewhere else. Based on our assessment, we will then be able to determine the right course of treatment, or if you actually need imaging.
Well, I’ve already got a scan and it says I’ve got bursitis…
That’s cool! Many of our patients who come in for shoulder pain have already had a scan done (usually referred by their GP). Whilst we will inspect the scan and report, our priority is to listen to your experience of your problem.
OK, so how do I treat bursitis?
Whilst exercising may seem like the opposite of what you want to do with a painful shoulder, an exercise-based treatment program is exactly what the research strongly supports. Compared to no treatment, exercise has been shown to improve shoulder pain and function in both the short-term (<1 month) and long-term (>3 months; Abdulla et al., 2015).
Even though we’re pro-exercise, we don’t advise picking any old exercise routine willy-nilly if you are currently experiencing pain with certain movements as this has the potential to aggravate symptoms. Going through a thorough assessment with a physiotherapist will help to identify what issues need to be addressed to help your shoulder, whether it’s muscle tension, reduced strength, or even contributions from other body parts. From there, you will be guided through exercises that will be most beneficial to you and are also least likely to further irritate your shoulder.
What about a cortisone injection?
If you’ve already had a scan, your GP may recommend a cortisone injection into the shoulder to reduce the amount of inflammation. Whilst cortisone injections can provide better short-term relief compared to exercise, the opposite is true in the long-term – patients who stuck with exercise therapy experienced less pain and much better function compared to those who had injections. Many who had the injection initially had lost all the pain relief by six months, and some even had worse pain and function (Pieters et al., 2020).
Based on the available research and guidelines on managing this type of shoulder pain, we don’t recommend cortisone injections as a first line treatment given its lack of long-term effectiveness.
How long will it take to get better?
It takes time to start seeing the benefits of exercise regardless of the reason you start. So whether it’s for weight loss, getting stronger, or reducing pain, we usually recommend sticking with the process for at least four to six weeks. This will give the muscles and other structures of the shoulder time to adapt and become stronger.
Interestingly, many patients report noticing a reduction in their pain much earlier than four weeks, which goes to show that even a little bit of exercise can be effective for reducing pain! But to ensure the issue doesn’t happen again, it’s a good idea to continue with the exercise program for the full recommended. Some new research by Schmidt et al. (2021) also supports that promoting the overall health of the shoulder –by keeping the muscles and tendons strong– can reduce friction and pressure on the bursa and thus prevent bursitis (and many other problems, too)!
Well, this sounds like my shoulder problem!
If you’ve been experiencing similar symptoms to the ones described above, pop in for a chat with one of our physiotherapists! We’ll be able to help you figure out what the issue is and put you on the right track to getting your shoulder moving again pain-free!
Abdulla, S. Y., Southerst, D., Côté, P., Shearer, H. M., Sutton, D., Randhawa, K., Varatharajan,
S., Wong, J. J., Yu, H., Marchand, A. A., Chrobak, K., Woitzik, E., Shergill, Y., Ferguson, B.,
Stupar, M., Nordin, M., Jacobs, C., Mior, S., Carroll, L. J., van der Velde, G., … Taylor-Vaisey,
A. (2015). Is exercise effective for the management of subacromial impingement syndrome
and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Manual therapy, 20(5), 646–656. https://doi.org/10.1016/j.math.2015.03.013
Park, S. W., Chen, Y. T., Thompson, L., Kjoenoe, A., Juul-Kristensen, B., Cavalheri, V., & McKenna, L. (2020). No relationship between the acromiohumeral distance and pain in adults with subacromial pain syndrome: a systematic review and meta-analysis. Scientific Reports, 10(1), 1-14.
Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., & Struyf, F. (2020). An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. journal of orthopaedic & sports physical therapy, 50(3), 131-141.
Schmidt, S. V., Engelhardt, J. A., Cools, A., Magnusson, S. P., & Couppé, C. (2021). Acromio-Humeral Distance Is Associated with Shoulder External Strength in National Elite Badminton Players-A Preliminary Study. Sports (Basel, Switzerland), 9(4), 48. https://doi.org/10.3390/sports9040048