Shoulder Subacromial Bursitis
A bursa is a fluid filled sac which is present in various locations around the body. It acts as a cushion between tendons and bones. Bursitis is an inflammation of a bursa and is associated with pain, swelling and tenderness in the affected area.
Bursitis usually results from an injury or from repetitive activities, although can result from more systemic conditions such as inflammatory arthropathy.
People usually find particular movements cause pain and a ‘catching’ feeling. Such movements are typically reaching overhead to get something out of a cupboard, or reaching behind such as retrieving an item from a rear car seat. Other people report less consistent causes of their pain, as well as stiffness.
Initially, painkillers and physiotherapy can be sufficient to improve symptoms. Physiotherapy is particularly important to address abnormal posture of the shoulder and to open up the subacromial space, as well as enhancing the control of the muscles around the shoulder, allowing the shoulder to work effectively.
You may go on to have a steroid injection into the subacromial space of your shoulder. This can work well with physiotherapy, as well as providing diagnostic information to confirm the location of the problem.
In cases resistant to non-surgical treatment, keyhole surgery may be required. The aim of surgery is to remove any inflamed bursa, and to increase the space available for the rotator cuff tendons to run, by removing some of the bone from the underside of the acromion. This keyhole (arthroscopic) surgery is usually performed as a daycase (home the same day) procedure.
After surgery the physiotherapy team will work with you to optimise your core stability, stabilise the shoulder and the shoulder blade and ensure they are working effectively. You will have a sling for comfort for a week or so but this can be discarded as soon as you feel able. Light two-handed activities can start after 2 weeks but you should avoid those provocative activities which previously caused pain such as reaching out abruptly or repetitive overhead activities. Moderate lifting can start at 4 – 6 weeks.
While the majority of people get better with physiotherapy and injections, those still with pain usually do well following surgery.