Definition and Causes
Shoulder bursitis, also known as subacromial bursitis or subdeltoid bursitis, is one of the most common causes of pain in the front and upper part of the shoulder.
A bag is a small bag filled with liquid placed inside a joint. Its main function is to reduce friction during movement by preventing a muscle or tendon from injury by rubbing against the bone.
The subacromial bursa is placed between the supraspinatus muscle, the deltoid muscle and the acromial process of the scapula. Due to repeated movements or severe trauma, this bag can become inflamed, drawing water into it. When the bursitis in the shoulder is caused by a violent impact or is associated with a tendon injury the subacromial bursa can also fill with blood.
The continuous repetition of small traumatic lesions can also lead to a chronic increase in the size of the bag, causing a pain that tends to become chronic without responding to physical therapies and rehabilitation.
Symptoms
The symptoms of bursitis in the shoulder are similar to those caused by the tendon inflammation of one or more muscles that make up the rotator cuff. These two conditions often occur simultaneously and are the result of the so-called "conflict syndrome". When the subacromial bursa swells, it presses on the cuff "trapping" the tendons and causing a mechanical irritation which gives rise to inflammation.
The accumulation of fluids inside the bag is responsible for the typical pain that occurs in the anterior upper part of the shoulder. This pain is accentuated on palpation and tends to limit the mobility of the joint, making the movements painful.
In the presence of a subacromial bursitis, the activities in which the elbow works under the shoulder during its abduction are particularly dangerous (shoulder press, slow with barbell, slow with dumbbells, flat bench, inclined bench, heavy side raises performed of momentum, pulled to chin)
Diagnosis
The Neer conflict test is positive (pain arises when the arm is passively raised forward on the plane of the scapula). Direct palpation over the subacromial bursa is essential for diagnosis (swelling and pain). Diagnostic investigations such as radiographs and magnetic resonance imaging are not normally necessary but can be performed to rule out complications (bone fractures, cuff injuries, conflict syndrome)
Care and treatment
In general, bursitis in the shoulder responds positively to rest and treatment with ice in the acute phase. Anti-inflammatory drugs have also been shown to be effective in promoting healing.
After this first phase, after 3-4 days from the trauma, the athlete can benefit by keeping the shoulder warm or by resorting to local heat applications.
If the shoulder bursitis does not respond positively to this type of treatment, local injections of steroids are necessary. However, cortisone may weaken the tendons that make contact with the bag, predisposing the subject to supraspinatus lesions.
To learn more: Drugs for Bursitis Care ยป
At other times when the bursitis in the shoulder becomes chronic, surgical removal of the bursa or parts of it can be used. In the absence of the aforementioned complications the healing time is on average about two or three weeks, at the end of which the athlete can easily resume the sporting activity.
