Bursitis of the Shoulder
What is bursitis?
Bursitis of the shoulder (impingement syndrome) occurs
when there is inflammation (swelling and redness) between
the top of the arm bone (humerus) and the tip of the
shoulder (acromion). Between these bones lie the tendons of
the rotator cuff and a fluid-filled sac (the bursa) that
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
What causes bursitis?
- An injury of the shoulder or falling on your
- Age. Shoulder bursitis is more common in people as
they become older.
- Infection (in-FEK-shun).
- Overuse of the shoulder in sports such as tennis,
swimming and baseball, especially from pitching and
throwing. Overuse can happen by doing activities that
cause you to raise your arms over your head a lot. These
activities include hanging wallpaper and painting.
- Rheumatoid arthritis (ahr-THREYE-tis). Bony growths
on your shoulder bones may rub against and irritate the
bursa and tendons.
What are the symptoms of bursitis?
- You may feel pain when you move your shoulder or
raise your arm over your head.
- You may have aching pain at rest.
- You may have pain that awakens you from sleep,
especially when you turn onto your sore shoulder.
- You may not be able to move your arm and shoulder as
much as usual.
- Your shoulder and upper arm may be weaker (not as
strong) than usual
How is bursitis diagnosed?
After discussing your symptoms and medical history, your
doctor will examine your shoulder. He or she will check to
see whether it is tender in any area or whether there is a
deformity. To measure the range of motion of your shoulder,
your doctor will have you move your arm in several different
directions. He or she will also test your arm strength.
Your doctor will check for other problems with your
shoulder joint. He or she may also examine your neck to make
sure that the pain is not coming from a "pinched nerve," and
to rule out other conditions, such as arthritis.
Other tests which may help your doctor confirm your
X-rays. Because x-rays do not show the soft tissues of your
shoulder like the rotator cuff, plain x-rays of a shoulder
with rotator cuff pain are usually normal or may show a
small bone spur. A special x-ray view, called an "outlet
view," sometimes will show a small bone spur on the front
edge of the acromion.
Are X-rays or MRIs needed to diagnose bursitis?
Studies such as x-rays and MRIs are not usually needed to
make the diagnosis of bursitis. While they are not needed
for diagnosis of bursitis, x-rays may be performed to ensure
there is no other problem, such as a fracture, that could be
causing the symptoms of pain and swelling. X-rays can show
evidence of swelling of the bursa, especially in the case of
olecranon bursitis. MRIs are also good tests identify
swelling, and will show evidence of bursitis. However, these
tests are not usually needed to confirm the diagnosis; MRIs
are usually only performed
The goal of surgery is to create more space for the
rotator cuff. To do this, your doctor will remove the
inflamed portion of the bursa. He or she may also perform an
anterior acromioplasty, in which part of the acromion is
removed. This is also known as a subacromial decompression.
These procedures can be performed using either an
arthroscopic or open technique.
Arthroscopic technique. In arthroscopy, thin surgical
instruments are inserted into two or three small puncture
wounds around your shoulder. Your doctor examines your
shoulder through a fiberoptic scope connected to a
television camera. He or she guides the small instruments
using a video monitor, and removes bone and soft tissue. In
most cases, the front edge of the acromion is removed along
with some of the bursal tissue.
Your surgeon may also treat other conditions present in
the shoulder at the time of surgery. These can include
arthritis between the clavicle (collarbone) and the acromion
(acromioclavicular arthritis), inflammation of the biceps
tendon (biceps tendonitis), or a partial rotator cuff tear.
Open surgical technique. In open surgery, your doctor
will make a small incision in the front of your shoulder.
This allows your doctor to see the acromion and rotator cuff
It is important to plan for the post-operative return
home prior to the surgery to ensure maximum comfort . For
most shoulder surgeries, the procedures can be performed as
an outpatient procedure or 1-2 days hospital stay. The
shoulder will be immobilized with a sling and it is
important to prepare the home ahead of time to ensure an
easier recovery. These are some of the tips that can be
helpful for preparation
- It is recommended that a family member or friend be
with you for the first few days until you are more
- Make sure you have rides planned from the hospital
and to your first follow-up visit.
- Most surgeons would not want your wound to be soaked
or cleaned prior to follow-up. You will not be able to
shower for the first week until the incision heals. Your
friend or family member can help you with sponge baths
and other hygienic care.
- As your arm will be in a sling for the first 4-6
weeks following surgery, you should place everything in
your house that you use on a regular basis at elbow
level. This way you will not have to raise your arm.
- You will not be able to drive while recovering from
shoulder surgery. Make sure all your important
appointments or meetings are scheduled before or after
the recovery period. If you have to travel to clinic
visits or physical therapy appointments, make sure that
you have rides or public transportation that allows you
to get to your destination safely.
- You should not eat or drink after midnight the day
before surgery; no breakfast or coffee on the day of
- Bring a list of your medications with you
- Bring a loose fitting shirt or jacket that you can
put over your shoulder; remember that you will be in a
sling after surgery and you will have difficulty putting
on a T-shirt or sweater
- The anesthesiologist will discuss with you the type
of anesthesia that you will be having; most patients
will have general anesthesia and also regional
anesthesia, known as a nerve block; the regional
anesthesia can decrease pain during surgery so that less
anesthetic agent is needed for general anesthesia and
the regional anesthesia can help control pain