Subacromial Bursitis

Description

Subacomial bursitis refers to the inflammation of the subacromial bursae, a fluid filled sack acting as a cushioning device to prevent friction between the supraspinatus muscle and the head of the arm (the humorous).

Subacromial bursitis occurs secondary to shoulder impingement, either primary or secondary shoulder impingement.

Predisposed by:

  • Degeneration of the AC joint, hooked acromium or osteophytes (spurs).
  • Poor shoulder biomechanics: poor posture, muscular imbalances, muscular tightness, capsular restrictions, incorrect motor patterns, poor lifting or throwing techniques.
  • Repeated overhead activities.

With repeated shoulder impingement the bursa can become aggravated. If this aggravation is continued and not allowed to settle the bursa will become inflamed, irritated and can become very painful. As the bursa is now enlarged it will be more susceptible to impingement and the bursitis will continue to get worse if you continue with your normal activities. An example of the development of bursits would be in an industrial worker who has poor shoulder biomechanics performing a job requiring a lot of overhead lifting. If the subacromial space is not maintained during the lifting, impingement will occur and the bursa will become aggravated, inflamed and painful. This may flair up from a single incident such as carrying a very heavy box or from repetitive trauma over many months.

Anti-inflammatories or a cortisone injection as prescribed by your doctor or specialist may help to settle your condition, however this
will not correct the predisposing factors causing this condition in the first place. In order to correct this you need a thorough biomechanical analysis as provided by the physiotherapists at Physiotherapy Associates.

Symptoms

Signs and symptoms of sunacromial bursitis:

  • Pain on the outside, front, back or top or your shoulder.
  • Quite often you will have a painful arc of abduction, this refers to pain when you hold your arm straight out to the side that decreases as you move higher or lower.
  • Discomfort at full shoulder movements.
  • Pain on the lateral side of the shoulder joint.
  • An ultrasound is sometimes used to diagnose subacromial bursitis.
  • Typically the supraspinatus muscle will be excessively tight.

Treatment

Treatment for subacromial bursitis

Quite often you will hear that massage will not help bursitis as it is not a muscle. This is true as massage on its own will not cure bursitis
however when you look into it you find that tightness of certain muscles will alter the biomechanics of the shoulder that will lead to the development of bursitis; so by releasing these muscles your shoulder will have improved function.

Treatment will include, as prescribe by your physiotherapist:

  • Rest from aggravating movements.
  • Ice.
  • Soft tissue mobilisations, joint mobilisations and appropriate stretches will all take pressure off the bursa.
  • Restoration of correct posture/movement patters.
  • Strengthening the rotator cuff stabilisers to ensure the shoulder moves properly.
  • Strengthening shoulder blade/scapula stabilisers ensuring the shoulder blade moves as required and gains the required upward rotation movement.
  • Strengthening the core/ the core posture to ensure the shoulder is not compensating for a dysfunction further down the body.
  • Functional rehabilitation/sports or task specific training.

Commonly patients with bursitis will have tried physiotherapy or other types of treatment providers with no success. This doesn’t mean that you have a condition that physiotherapy cannot help, it generally means an incorrect diagnosis was made and treatment was done inappropriately such as strengthening of the rotator cuff before muscular tightness and capsular restrictions were addressed. As with all injuries it is important to address the entire functioning body because for example; if the bursitis was actually being caused by a stiff thoracic spine no amount of massage or rotator cuff strengthening will fix your problems. Strengthening is vitally important to ensure the correct shoulder stabilisation is occurring through all your movements however these need to be brought in at the correct time and they need to be relevant to your function, be it your job or your sport.