Understanding Shoulder Bursitis: A Physiotherapist’s Perspective by Megan Schneider Senior APA Physiotherapist
Shoulder bursitis is a common cause of shoulder pain that can significantly impact daily activities, especially movements involving lifting or overhead activity. As physiotherapists, our role is essential in both diagnosing and managing this condition conservatively to restore function and reduce pain. In this blog, we’ll explore what shoulder bursitis is, how it presents, and the evidence-based physiotherapy approaches to treatment.
What is Shoulder Bursitis?
Bursae are small fluid-filled sacs that reduce friction between tissues such as bone, muscle, and tendons. In the shoulder, the most commonly affected bursa is the subacromial bursa, which sits between the rotator cuff tendons and the acromion (part of the shoulder blade).
Shoulder bursitis occurs when this bursa becomes inflamed, typically due to overuse, repetitive overhead activity, trauma, poor shoulder function or underlying conditions such as rheumatoid arthritis. It may also develop alongside rotator cuff tendinopathy.
Symptoms of Shoulder Bursitis
Common clinical signs and symptoms include:
• Pain at the top or outer part of the shoulder, especially with overhead movements
• Pain at rest or when lying on the affected side
• Reduced range of motion in the shoulder
• Localised tenderness over the subacromial area
• Swelling or warmth in acute cases
• Pain may be worse at night, interfering with sleep
These symptoms can overlap with other shoulder conditions, making a thorough assessment essential.
Diagnosis of Shoulder Bursitis
A physiotherapist will conduct a detailed subjective and objective assessment, including:
• History taking: Onset, activity level, occupation, previous injuries
• Physical examination:
1. Palpation to assess tenderness over the bursa
2. Range of motion testing to identify limitations
3. Special tests: Hawkins-Kennedy, full and empty can, or Neer’s test to assess impingement
4. Muscle strength testing for rotator cuff involvement
· Imaging Studies: While clinical evaluation is primary, imaging modalities like ultrasound or MRI may be employed to confirm the diagnosis or exclude other pathologies.
Physiotherapy Management of Shoulder Bursitis
Treatment focuses on reducing pain and inflammation, restoring normal biomechanics, and preventing recurrence.
1. Pain and Inflammation Management
• Relative rest from aggravating activities (e.g., overhead lifting)
• Cryotherapy (ice application) in the acute phase
• Taping may help to offload the shoulder
• Education on posture, sleeping and activity modification
2. Manual Therapy
• Joint mobilisations to improve glenohumeral and scapulothoracic mobility
• Soft tissue techniques to relieve muscle tension around the shoulder girdle
3. Exercise Therapy
• Pain free range of motion exercises in the early stages
• Progressive strengthening for the rotator cuff and scapular stabilisers. Commencing with isometric exercises and continuing to isotonic exercises.
• Postural correction exercises targeting thoracic extension and scapular retraction
4. Addressing Contributing Factors
• Ergonomic assessment (e.g., workstation setup)
• Technique modification in sports or occupation
• Education on load management
5. Adjunct Modalities
• Ultrasound therapy or TENS may be used in some clinics, though evidence is mixed
• Dry needling can be beneficial for muscular trigger points surrounding the shoulder
Prognosis
With early intervention, most cases of shoulder bursitis respond well to conservative physiotherapy 8-12 weeks. Chronic or recurrent bursitis may take longer and may require more structured rehabilitation. Adherence to prescribed exercises and activity modifications is crucial for optimal recovery. If conservative management fails, medical interventions such as corticosteroid injections may be considered, but they should not replace active rehabilitation.
If you’re dealing with shoulder pain that doesn’t improve, a physiotherapy assessment can help identify the root cause and get you on a structured path to recovery. Early intervention, tailored exercise, and postural education are key in managing shoulder bursitis effectively.
References
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National Center for Biotechnology Information. (2022). Bursitis. In StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK541096/
Resilience Orthopedics. (n.d.). Exercises for shoulder bursitis. https://www.resilienceorthopedics.com/shoulder/exercises-shoulder-bursitis/
Summit Physical Therapy. (n.d.). Physical therapy for shoulder bursitis. https://www.summitpt.info/blog/physical-therapy-for-shoulder-bursitis
University of Utah Health. (n.d.). Shoulder bursitis. https://healthcare.utah.edu/orthopaedics/specialties/shoulder-pain/bursitis