Shoulder Bursitis Treatment

Shoulder bursitis is a painful condition caused by inflammation of the small fluid-filled sacs called bursae, which are located around the shoulder joint and function to reduce friction during movement.

In the shoulder region, bursae such as the subacromial, subdeltoid, and subscapular bursae can become inflamed due to various reasons. This inflammation often leads to pain with shoulder motion, limited range of motion, and a notable decline in quality of life.

It is especially common in athletes who frequently raise their arms overhead, manual laborers, and individuals who perform repetitive upper body activities in daily life.

Fortunately, with proper diagnosis and effective treatment, the symptoms of shoulder bursitis can often be controlled and recurrence can be prevented using non-surgical methods.

What Is Bursitis?

Bursitis is the inflammation and irritation of the bursae – small, fluid-filled sacs located around the joints that help reduce friction between bones, muscles, and tendons during movement.

These structures also serve a protective function, absorbing external impact during trauma, much like an airbag in a car.

When subjected to repetitive stress, overuse, or trauma, bursae can become inflamed and tender, leading to pain, swelling, and limited joint mobility.Bursitis can affect many joints, but it is particularly common in the shoulder, elbow bursitis, hip, and knee – joints that are frequently used in daily activities.

What Is Shoulder Bursitis?

Shoulder bursitis refers to inflammation of one or more bursae around the shoulder joint. These sacs – especially the subacromial, subdeltoid, and subscapular bursae – may swell and become painful due to irritation.

Inflammation in these bursae can lead to pain during shoulder movement, difficulty performing daily activities, and a decreased quality of life.

Shoulder bursitis is commonly seen in individuals involved in overhead sports (like swimming, tennis, or volleyball), physical labor, or those who have suffered direct trauma to the shoulder.

With an accurate diagnosis and timely, appropriate treatment, shoulder bursitis can be effectively managed and overall function and comfort can be restored.

What Causes Shoulder Bursitis?

Shoulder bursitis usually develops as a result of repetitive overhead motion, overuse, or direct trauma to the shoulder. Sports like swimming, tennis, and volleyball, and professions such as painting or construction work, can put repetitive stress on the shoulder bursae.

Other contributing factors include:

• Shoulder impingement syndrome

• Muscle imbalances

• Poor posture

• Age-related changes

• Less commonly, rheumatic diseases or infections may also lead to bursitis.

Common causes of shoulder bursitis:

• Repetitive Overhead Movements: Activities or sports requiring frequent overhead arm use may irritate the bursae.

• Shoulder Impingement Syndrome: Compression of tendons and bursae in a narrow space within the shoulder may promote inflammation.

• Direct Trauma or Fall: Impact on the shoulder can damage the bursae and trigger inflammation.

• Muscle Weakness or Imbalance: Weak rotator cuff muscles may lead to abnormal movement and increased stress on bursae.

• Poor Posture Habits: Slouched posture or forward-rolled shoulders may increase pressure on shoulder bursae.

• Rheumatic Conditions: Diseases like rheumatoid arthritis may cause chronic inflammation of the bursae.

• Advanced Age and Degenerative Changes: Aging can make shoulder structures more susceptible to irritation.

• Infections (Rare): In some cases, bacterial infection may lead to septic bursitis.

What Are the Symptoms of Shoulder Bursitis?

The main symptoms of shoulder bursitis include pain and restricted shoulder movement. Pain usually worsens when lifting the arm overhead or when lying on the affected shoulder.

Patients often experience difficulty with daily activities such as dressing, combing hair, or reaching for items on a shelf. There may also be swelling, tenderness, and a feeling of warmth around the joint. In more advanced cases, night painmay occur, disrupting sleep.

If left untreated, shoulder mobility can become more limited, and muscle weakness may develop due to underuse.

Common symptoms of shoulder bursitis:

• Shoulder Pain:

  • Worsens with arm elevation or overhead activities.

• Limited Range of Motion:

  • Difficulty in fully lifting the arm or reaching behind the back.

• Pain When Lying on the Shoulder:

  • Night pain often intensifies when pressure is applied to the affected side.

• Swelling and Tenderness:

  • Swelling and sensitivity to touch around the shoulder joint.

• Increased Warmth:

  • A sign of inflammation in the affected area.

• Difficulty with Daily Tasks:

  • Pain and weakness during activities such as dressing or lifting objects.

• Sleep Disturbances:

  • Persistent pain may disrupt sleep quality.

How Is Shoulder Bursitis Diagnosed?

The diagnosis of shoulder bursitis is primarily made through a detailed review of the patient's symptoms and a thorough physical examination.

During the exam, pain that increases when the arm is raised overhead or when pressure is applied to the shoulder often supports the diagnosis. However, to determine the severity of inflammation, identify any underlying issues, or detect associated muscle or tendon injuries, imaging techniques such as ultrasound and MRI may be necessary.

Ultrasound is particularly valuable in diagnosing shoulder bursitis as it provides a quick and dynamic evaluation of the soft tissues in real time.

How Is Shoulder Bursitis (Fluid Accumulation) Treated?

The main goal in treating shoulder bursitis – also referred to as fluid accumulation in the shoulder – is to reduce inflammation, control pain, and restore normal shoulder function. In most cases, proper treatment can resolve the condition without surgery.

Initial treatment includes:

• Rest and avoiding overhead or repetitive movements

• Anti-inflammatory medications

• Physical therapy

In more resistant cases, ultrasound-guided corticosteroid injections or biologic therapies such as PRP (Platelet-Rich Plasma) or exosome therapy may be considered.

At every stage of treatment, it is crucial to strengthen the muscles around the shoulder and develop proper movement habits. Surgery is rarely needed but may be considered if non-surgical methods fail.

Non-Surgical Treatments for Shoulder Bursitis

Non-surgical treatments are always the first line of therapy for shoulder bursitis. With the right approach in the early stages, most patients recover without the need for surgery.

Key non-surgical treatments include:

• Activity modification: Reduce strain on the shoulder and avoid repetitive motions.

• Medications: Oral anti-inflammatories (NSAIDs) may be prescribed to manage pain and inflammation.

• Physical therapy: Helps improve range of motion, strengthen surrounding muscles, and reduce inflammation.

• Ice therapy: Applying ice 4–5 times a day for 20 minutes can reduce swelling and ease pain by constricting blood vessels.

• Rest: Essential to support the healing process.

Shoulder Bursitis Exercises

When initiated correctly, exercises can accelerate healing and help restore pain-free movement. It’s important to start with gentle stretching and mobility exercises under the guidance of a specialist and gradually increase intensity.

Exercises should never be painful. A progressive exercise program helps strengthen the shoulder muscles, preserve range of motion, and reduce recurrence.

Exercises that target the rotator cuff and scapular stabilizers are particularly beneficial.

3 Recommended Exercises for Shoulder Bursitis

1. Pendulum Exercise:

   • Support one arm on a table or chair.

   • Lean forward and let the affected arm hang freely.

   • Gently swing the arm in small circles forward, backward, and sideways.

   • Perform for 30 seconds in each direction several times daily.

2. Passive Shoulder Flexion:

   • Use your healthy arm to hold the wrist of the affected arm.

   • Slowly lift the affected arm forward until you feel a gentle stretch.

   • Hold for 5 seconds, then slowly lower.

   • Repeat 10 times.

3. Wall Climb Exercise:

   • Stand facing a wall.

   • Use your fingers to “climb” the wall upward with your affected arm.

   • Go up to a pain-free point, hold for 3–5 seconds, then return down.

   • Repeat 10 times.

Injection Therapy for Shoulder Bursitis

For patients who do not respond to non-invasive treatments, injection therapy can offer effective relief. Ultrasound-guided injections allow direct delivery of medication to the inflamed bursa, improving outcomes and minimizing complications.

Corticosteroid injections reduce inflammation and provide quick pain relief. However, biologic therapies have gained popularity in recent years for their regenerative potential.

• PRP (Platelet-Rich Plasma) and Sanakin (ACS – Autologous Conditioned Serum), derived from the patient’s own blood, promote healing and provide longer-lasting relief.

• These are especially helpful in recurrent cases or when steroids are contraindicated.

Ultrasound guidance ensures the medication is injected precisely into the inflamed bursa, especially in the front and top parts of the shoulder where the inflammation is typically located.

Surgical Treatment of Shoulder Bursitis

Most shoulder bursitis cases are successfully treated without surgery. However, if pain, stiffness, and loss of function persist despite comprehensive non-surgical care, surgery may be considered.

Arthroscopic surgery (minimally invasive) is the preferred technique. During this procedure:

• The inflamed bursa is removed.

• Any bone spurs or impingement-related deformities (e.g., under the acromion) are corrected.

Arthroscopy offers faster recovery and minimal disruption to the shoulder's anatomy. Postoperative physical therapy helps restore range of motion and muscle strength progressively.

Frequently Asked Questions (FAQ) About Shoulder Bursitis

1. What is shoulder bursitis?

   Shoulder bursitis is inflammation of the fluid-filled sacs (bursae) around the shoulder joint, causing pain and stiffness.

2. What causes shoulder bursitis?

   Repetitive motion, overhead activity, impingement, trauma, and some autoimmune diseases may contribute.

3. How is it treated?

   Rest, ice, medications, physical therapy, and injections are common. Surgery is reserved for resistant cases.

4. Are injections effective for shoulder bursitis?

   Yes, especially when performed under ultrasound guidance, injections can be highly effective.

5. Do PRP or Sanakin (ACS) work for bursitis?

   Yes, these biologic treatments support tissue healing and provide longer-lasting relief.

6. What exercises help shoulder bursitis?

   Pendulum swings, wall climbs, and passive flexion are safe and effective when performed correctly.

7. Can shoulder bursitis heal on its own?

   Mild cases may resolve with rest and home care, but persistent symptoms require medical evaluation.

8. How long does shoulder bursitis last?

   With proper care, recovery may take a few weeks, but some cases may last several months.

9. How is shoulder bursitis surgery performed?

   It’s done arthroscopically by removing inflamed tissue and correcting any mechanical impingement.

10. How can I prevent shoulder bursitis?

    Strengthening shoulder muscles, avoiding repetitive overhead activity, and using proper technique help prevent bursitis.

Conclusion

Shoulder bursitis is a manageable condition when diagnosed early and treated appropriately. Non-surgical methods such as rest, physical therapy, medications, and targeted injections can often resolve symptoms without the need for surgery.

Ultrasound-guided injection therapies offer a precise and effective option by delivering treatment directly to the inflamed area.A personalized treatment approach ensures faster recovery and long-term shoulder health.

If you're experiencing persistent shoulder pain that interferes with your daily life, it’s important to consult an orthopedic and sports medicine specialist for early evaluation.

Dr. Utku Erdem Özer is here to support your shoulder health and help restore your quality of life.