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There are multiple types of shoulder pain, which can range from mild aches to severe pain, to the point where you may not be able to raise your arm. However, if you’re experiencing intense pain in your shoulder that gets worse when trying to move, you might have a problem called subacromial bursitis. This is an inflammation in the bursal sac around your shoulder joints. 

If you suspect you are suffering from subacromial bursitis or another shoulder issue, seek treatment from your orthopaedic surgeon immediately – getting treatment for shoulder injuries or shoulder joint problems early on can help prevent long term pain and damage.

What is Subacromial Bursitis?

Subacromial bursitis is commonly identified by intense pain in and around your shoulder joint, which may require surgery.  This is caused by the bursae or bursa sacs around your shoulder swelling and filling up with more fluid than should normally be there. Bursa sacs are filled with fluid meant to pad or cushion the bones and tendons that make up your joints. When overfilled, this condition is called bursitis and causes severe pain and difficulty moving the joint and raising or rotating your arm.

The subacromial bursa sac is located in your shoulder joint, separating the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament, acromion, and coracoid (the acromial arch) from the deep underlying surface of the deltoid muscle.

 

bursa anatomy

Bursa are small sacs of fluid meant to pad & cushion bones and tendons

To put it simply, this bursa sac is associated with the group of tendons and muscles that make up your rotator cuff. When it’s inflamed or swollen, you have subacromial bursitis or shoulder bursitis. Your shoulder joints are some of the most common places to experience bursitis or issues with your bursa sacs; similar problems can also occur in your hips, elbows, knees, ankles, and feet.

The subacromial bursa sac is located in your shoulder joint, separating the superior surface of the supraspinatus tendon (one of four that make up the rotator cuff) from the overlying coraco-acromial ligament, acromion, and coracoid (the acromial arch) from the deep underlying surface of the deltoid muscle.

This is one of the most common causes of shoulder pain and generally is the result of shoulder impingement which occurs when the shoulder bursa become inflamed and swell with fluid, causing irritation and pain when the arm is raised above shoulder height, narrowing the space with the acromion bone and rotator cuff, therefore causing it to rub against or “impinge” on the tendon and bursa sac.

When this happens around the bursa sacs located near your rotator cuff tendons and bone (the acromion). Subdeltoid bursa sacs can also become inflamed and cause pain, but this problem is less common. Unstable shoulder joints (e.g. when there is excessive joint movement, ligament laxity, or muscular weakness due to repetitive activity, trauma, previous poorly healed injury, bad posture, or general inactivity) are more prone to bursitis in general.

Causes of Subacromial Bursitis

Generally, shoulder bursitis or subacromial bursitis is caused by an injury or overuse of the shoulder muscles. Repetitive movements, lots of overhead lifting and forceful pulling, or sports involving significant arm movements, such as throwing can all cause problems with your shoulders and subacromial bursa sacs.

Shoulder bursitis can either be primary (there are underlying problems with the structure of the shoulder) or secondary (repeated movement or activity have damaged the joint). Your age, posture, and flexibility can also contribute to subacromial bursitis.

For instance, shoulder bursitis becomes more likely as you get older, poor posture or constant slumping can cause stress and shoulder issues, and poor flexibility and not stretching before you work out or play your sport of choice can all be contributing factors. Infections and chronic illnesses or diseases like arthritis, diabetes, and thyroid problems can also increase the likelihood you’ll develop shoulder bursitis or similar issues.

Moreover, the actual shape and placement of the bones in your shoulder can be a contributing factor to subacromial bursitis. If you happen to have less space between your tendons and bursa sacs than most people, you are more likely to develop shoulder bursitis, especially if your job or sport(s) of choice involve lots of overhead lifting, throwing, or pulling.

Bone overgrowths can occur under the acromion (spurs) which reduces the space within the shoulder and leads to impingement and bursitis. Also, the position and control of the scapula (shoulder blade) can also narrow the subacromial space and compress and irritate the bursa.

View our shoulder surgeon, Dr. Devinder Garewal explains what causes Subacromial Impingement & Bursitis: 

Key symptoms of subacromial bursitis

Stiffness and pain in your shoulder are the main symptoms of subacromial bursitis. The shoulder in question will likely be sore to the touch, particularly on the front side or around the upper arm area. Your shoulder pain may be extreme enough to wake you up at night, and your shoulder area might be swollen and red.

More advanced subacromial bursitis may mean you will have a “frozen shoulder” and you will not be able to move your shoulder very much at all, at least not without severe pain. If you suspect that you have shoulder bursitis or are experiencing other types of shoulder pain, you should see your orthopaedic shoulder surgeon or doctor for shoulder tests, since more severe cases can require surgery.

If you are experiencing a gradual onset of shoulder pain over a series of weeks or months on the outside of your shoulder (particularly if it spreads down your arm toward the elbow or wrist), you may have subacromial bursitis. Shoulder bursitis often is connected to or coexists with rotator cuff tears or rotator cuff tendinopathy, as it can cause difficulty performing everyday activities like washing your hair.

How is subacromial bursitis diagnosed?

If you are experiencing the aforementioned symptoms, it’s time to check in with your orthopaedic surgeon because it is likely you have bursitis in shoulder or similar issues.

Your doctor should ask you about your symptoms, check to see if the shoulder that’s causing the pain is warm to the touch or particularly tender, and gently move your arm in various directions to see your range of motion and any pain associated with certain types of movements.

It is likely that your doctor will want X-rays and imaging tests to rule out other ailments like arthritis that can cause some of the same symptoms as subacromial bursitis. An X-ray can also check for extra bone or spurs under the acromion that might be impinging on the space and causing the bursitis.

An MRI or ultrasound scan may also be ordered to see if your bursa sacs are filled with extra fluid; the doctor may also order a blood test to see if there is an infection causing the problem, and in some cases fluid from your shoulder bursa sac will be drained and tested.

How is subacromial bursitis treated?

Of course, it all starts with a visit to an orthopaedic surgeon to diagnose the problem. If you do indeed have subacromial bursitis or a similar condition, then there are multiple treatment options for shoulder bursitis available to you, depending on the severity of your particular case and the symptoms you are dealing with.

Everything from simple rest and relaxation and icing your shoulder joint regularly to physical therapy or physiotherapy and even surgery may be required to ease your pain and help mitigate the condition.

Removing any potential causes of primary and secondary shoulder impingement – which lead to shoulder bursitis – is often the key to treating subacromial bursitis and preventing future related issues.

Improving your posture and using physical therapy and specific exercises to increase shoulder stability, scapula exercises and shoulder blade position and control, rotator cuff strength, and flexibility are generally advised; as always consult your doctor and physical therapist or physiotherapist about the best course of treatment and action plan if you’ve been diagnosed with subacromial bursitis.

deltoid pain

What are the potential treatments for subacromial bursitis?

Treatments for shoulder bursitis are generally fairly simple. You’ll need to rest and refrain from the activities that likely caused the bursitis in the first place, and over-the-counter painkillers like ibuprofen, naproxen, paracetamol or aspirin are commonly recommended. Daily cold packs are also typically considered a good idea, along with exercises or even physical therapy or physiotherapy in more difficult cases.

These shoulder bursitis exercises are aimed at reducing the pain and improving the range of motion in your shoulder joints. You may be advised to wear a sling or brace, or tape your shoulder in order to keep your shoulder immobilized while its healing.

Sleeping relatively upright using pillows to keep your shoulder in an ideal position may also be recommended if you are dealing with subacromial bursitis. If an infection is the cause of your shoulder bursitis, you’ll require a course of antibiotics.

If these simple treatment options fail, a doctor may inject a corticosteroid or similar drug into your shoulder area for more immediate relief. Using ultrasound guidance can be useful to ensure the subacromial bursal injection is introduced into the correct area.

The corticosteroid works to reduce the inflammation within the bursa and whilst the pain is reducing, it is a good opportunity to attempt more physical therapy and physiotherapy exercises to overcome the subacromial bursitis.

Of course, check with your orthopaedic surgeon before you follow any treatment plans or ideas for your subacromial bursitis, and work with them and a physical therapist or similar professionals before you return to work or your sport(s) of choice that may have caused the problem to begin with.

Does subacromial bursitis require surgery?

If you are dealing with shoulder bursitis, chances are that surgery won’t be required, since most cases improve after a few weeks of home care and exercises combined with rest and relaxation.

However, if your shoulder pain and condition isn’t improving, surgery may be advised. This involves removing the inflamed shoulder bursa sac so that a new and healthy one can grow in the same place.

This surgery may also involve removing some bone from the undersurface of your acromion in order to make more room for your rotator cuff tendons and improve your range of motion.

In instances when there is a spur or bony overgrowth on your X-rays your orthopaedic surgeon might recommend surgery in the first instance to remove this bony impingement which is causing the compression of the bursa.

Most of these operations are performed using key hole surgery (arthroscopy or arthroscopic shoulder surgery). It is a relatively minor procedure that is performed as a day case (discharge home after the procedure on the same day).

Your arm will be in a sling to rest for a few days after the surgery before it can be removed and you can start to move and use your arm and shoulder thereafter.

As always, speak with your orthopaedic surgeon if you suspect you are dealing with subacromial bursitis or any other shoulder issues. They will help you determine the ideal course of action and which procedures (if any) will help solve your problems and reduce or eliminate your shoulder pain.