Shoulder bursitis is a very common diagnosis for shoulder niggles. An ultrasound scan is frequently one of the first diagnostic tests someone is sent for following development of pain in the front of the shoulder. Unfortunately, it often comes back positive – and a structure is revealed to treat. But, very rarely is it truly the primary problem. The question should be “how” and “why” factors. Solve these and your shoulder pain will fully resolve for the long term.
The shoulder design is amazing:
A ball and socket and numerous muscles threading through a capsule or sleeve that surrounds the joint. Every muscle has a key role in tensioning and positioning the ball in the socket. If any one of them is not functioning well, the ball (humerus) slips a little north and starts to bump on the small cushion – the bursa that sits between the top of the ball and the AC joint (the point of the shoulder).
So – the issue here is not the fact that the bursa has been bumped over and over through sports or work activities, and is swollen and painful– it is trying to work out what is causing this to happen.
Causes of Bursitis:
This can occur from a range of things.
Sometimes it is a muscle strain or tear causing some weakness in one of the muscles. This is often one of the rotator cuff muscles. Or, it could be an issue with your posture and weakness of your upper back and shoulder blade muscles. This results in the socket not sitting in its proper position resulting in more of the humerus travelling north. It could also be repetitive activities – day to day or from a weekend warrior activity that your body is unaccustomed to.
Signs & Symptoms:
Pinching pain on elevating the arm, sometimes an ache that can come on after you do something – eg reach overhead or lifting an object out in front of you. Ache at night, Ache in the morning. It can vary a lot.
The Assessment and Treatment:
A thorough biomechanical assessment of the shoulder is the best way to start to determine what is happening. From there, based on findings, an exercise program can often assist in restoring the “best possible” orientation of the joint. This in turn should relieve the pressure on the bursa, and help with long term solutions beyond just an injection, medications or some hands on treatment.
An injection may be a key part of the treatment process if it is not responding to conservative treatment. Key here though is – if you have an injection – you still need to determine the cause and work on fixing the biomechanical problem or work activities that caused the bursa to swell in the first place.
It takes a while to restore adequate strength to correct the biomechanics if this was the cause – but you should be getting some significant change within a couple of weeks of exercises.
Local pain may reduce at least a little within a couple of treatments. Key thing is determining the cause.
An injection can help – but you then need to work on the biomechanical cause if there was one to prevent it from returning. That can take a wee bit of time.
Need help? Think this might be you? Book in and talk to one of our CORE Physiotherapists and try and get to the source of the issue.
Donna McCook – Physiotherapist, Exercise Physiologist and one of our Exec Directors at CORE has over 25 years of clinical experience in musculoskeletal physiotherapy, and works extensively in the area of Back and Shoulder Pain Treatment and Rehabilitation. Donna is available for appointments at our Corinda, Banyo and Beenleigh clinical sites. Read more about Donna McCook and the rest of our team here.