Bursitis of the Shoulder

What is bursitis of the shoulder?

Bursitis of the shoulder (impingement syndrome) occurs when there is swelling and redness between the top of the arm bone and the tip of the shoulder. Between these bones lie the tendons of the rotator cuff and a fluid-filled sac called the bursa, which protects the tendons.

Normally, the tendons slide effortlessly within this space. In some people, this space becomes too narrow for normal motion. This causes irritation to the tendons and bursa, which become inflamed. Inflammation causes the tendons and bursa to swell, making the space for movement still smaller. Eventually, this space becomes too narrow for the tendons and the bursa. Every time they move, they are pinched between the bones. This is the impingement.

What causes bursitis of the shoulder?

The most common causes of bursitis are injury or overuse. Infection may also cause it.

Bursitis is also associated with other problems. These include arthritis, gout, tendonitis, diabetes, and thyroid disease.

In many people with this problem, the shape of the bones is such that they have less space than most other people. Even small thickenings of the tendons or bursa can cause symptoms.

What are symptoms of bursitis of the shoulder?

Often there is an initial injury that sets off the inflammation. After that, the problem can spiral into a worse condition. This inflammation causes a thickening of the tendons and bursa. The thickening then takes up more space, pinching on the tendons and bursa even more. This causes more inflammation, and more thickening of the tendons and bursa, and so on.

How is bursitis of the shoulder diagnosed?

In addition to a complete medical history and physical exam, diagnostic tests for bursitis may include:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to make pictures of internal tissues, bones and organs on film.
  • Magnetic resonance imaging. An imaging test that uses a combination of large magnets, radiofrequencies and a computer to make detailed pictures of organs and structures within the body.
  • Ultrasound. An imaging test that uses high-frequency sound waves to look at the internal organs and tissues.
  • Aspiration. A procedure that involves using a thin needle to remove fluid from the swollen bursa to check for infection or gout as causes of bursitis.
  • Blood tests. Lab tests may be done to confirm or rule out other conditions.

How is bursitis of the shoulder treated?

Nonsurgical Treatment

Reducing the inflammation is the first step in treating shoulder bursitis. Avoid doing the things that cause pain, such as reaching or stretching beyond your comfort zone. Inflammation can also be treated with anti-inflammatory medications such as Motrin or Advil. These drugs help reduce the swelling and pain.

For many patients, a few weeks of these measures will be enough to treat shoulder bursitis. After the pain is gone, simple exercises or physical therapy may help you return to normal, pain-free activities.

If the symptoms don't go away, the next step is usually a cortisone injection, or steroid shot, into the swollen area. Cortisone is a powerful drug that treats swelling, not pain. If your initial symptoms are significant, your doctor may give you a cortisone injection on your first visit. The most significant downside is that cortisone injections may weaken tendons. Repeated cortisone injections should be considered with care.

Surgical Treatment

Surgery is sometimes needed to treat shoulder bursitis. This can be done using a small incision with a special, minimally invasive probe called an arthroscope. During the surgery, the inflamed bursa, some of the bone and any spurs are removed to create a larger space for the rotator cuff tendons.

What can I do to prevent bursitis?

Try the following measures to prevent bursitis:

  • Warm up before exercising or before sports or other repetitive movements.
  • Start new exercises or sports slowly. Gradually increase the demands you put on your body.
  • Take breaks often when doing repetitive tasks.
  • Cushion “at risk” joints by using elbow or knee pads.
  • Stop activities that cause pain.
  • Practice good posture. Position your body properly when doing daily activities.

When should I call my healthcare provider?

Call your healthcare provider if you have any of the following:

  • Pain or trouble moving affects your regular daily activities
  • Pain doesn’t get better or gets worse with treatment
  • A bulge or lump develops at the affected joint
  • Redness or swelling develops at the affected joint
  • You have fever, chills or night sweats

Key points

  • Bursitis is inflammation of a bursa, a closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body. Bursitis of the shoulder (impingement syndrome) occurs when there is swelling and redness between the top of the arm bone and the tip of the shoulder.
  • The most common causes of bursitis are injury or overuse. Infection may also cause it.
  • To relieve bursitis of the shoulder, avoid doing the things that cause pain. The condition can also be treated with anti-inflammatory medications such as Motrin or Advil.
  • Cortisone shots and surgery may also be used to treat the condition.

Videos

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