Shoulder bursitis is an extremely common condition that we see in the clinic.
Shoulder bursitis is a common condition that causes pain, inflammation, and swelling in the shoulder. It affects both males and females, and generally people of all ages from their 20’s and upwards.
The bursa is a small, fluid-filled sac that cushions the bones and tendons in the shoulder joint. We have bursa throughout most of the movable joints in our bodies, though the shoulder has a particularly large bursa, namely the ‘subacromial’ bursa.
When this bursa becomes inflamed, it can cause pain and limit movement.
This pain is often felt around the side and front of the shoulder joint, though can radiate around the back at times, and sometimes down the side of the arm.
The interesting thing to note in a successful recovery for shoulder bursitis is not so much in confirming that the bursa is a source of pain, though rather, why is the bursa the source of the pain? What is causing it to become irritated?
This could be due to poor technique, weak scapular muscles, weak rotator cuff muscles, multidirectional instability of the shoulder joint; the list goes on.
This is where an accurate assessment of your shoulder by a skilled practitioner can really help identify the root cause of your shoulder bursitis, and then allow you to seek appropriate treatment in order to fix your shoulder bursitis pain.
As mentioned earlier, a thorough clinical examination by a skilled physiotherapist in Melbourne can help give you a clear diagnostic picture of your shoulder bursitis.
Often people attend our sports physiotherapy clinics having already seen their doctor and have had an ultrasound scan to image their shoulder. This is handy, though often not required.
We often use the scans to rule out other pathologies and make sure the tendons and muscles are in good structural condition.
What's really interesting is that up to 78% of people with no shoulder pain have been shown to have shoulder bursitis on an ultrasound.
This can be a trick, or a red herring, for in-experienced practitioners, because they often get caught up treating someone’s bursitis which isn’t actually causing the problem. It is just something that flashes up on a scan, though isn’t part of the pain process, as the pain is from another source.
The key thing to realise when diagnosing shoulder bursitis is that the scan result is part of the diagnostic puzzle, not the final answer.
Skilled physiotherapist needs to take in your personal history and your clinical test findings, along with your imaging, to get a good diagnostic answer for your shoulder bursitis.
It is also important to note that you don’t always need a scan to diagnose and fix your shoulder bursitis.
What is the best treatment for shoulder bursitis? Can physiotherapy help shoulder bursitis?
Traditionally, shoulder bursitis has been treated with a cortisone injection into the bursa, and closely followed by a period of rest.
This tends to give short term relief for some people, though may also provide zero change to some individuals.
What is commonly missed in shoulder pain patients that fail to achieve their outcomes is a targeted and specific physiotherapy-led strengthening regime to restore normal function to the rotator cuff muscles.
There are multiple research articles suggesting that a targeted strengthening regime is the most successful treatment for a long term fix to shoulder bursitis.
This is more important in the chronic shoulder bursitis situations, as the longer someone is in pain generally the more dysfunction the rotator cuff muscle group is in. Though getting this under control in the acute injury phase stops people drifting into chronic cases.
SO WHAT IS THE ROTATOR CUFF, AND WHAT HAS IT GOT TO DO WITH FIXING MY SHOULDER BURSITIS?
The rotator cuff is simply a group of four muscles that begin on your shoulder blade and continue their journey to the ball of your socket in your shoulder.
These muscles are deep in our body underneath the more famous muscles such as the biceps, tricep and deltoids. The rotator cuff muscles main role is simply to keep the ball (humeral head), within the socket (glenoid).
The issue with pain in the shoulder area is that pain driven muscle inhibition occurs.
Put simply, pain in the local shoulder area is interpreted by the brain as a threat, and the brain subsequently and automatically reduces the output of the rotator cuff muscles.
In the short term the brain does this to reduce the threat or impact of any particular injury, though this does not work in the long term as the rotator cuff muscles fail to perform as they should, and the ball is not held dead centre in the socket.
This then allows the ball to move a couple of millimetres and allows the ball to then impinge internally on the rotator cuff tendons and also the bursa.
This irritates the bursa and the rotator cuff tendons, which may produce what many people see on ultrasound scans as bursitis.
So the issue with a simple cortisone injection to settle bursitis does not actually address the root cause of having muscle imbalances and reduced endurance for excellent shoulder micro-stability.
SHOULD YOU GET A CORTISONE INJECTION TO FIX SHOULDER BURSITIS?
Well, yes, and no. It really depends on your individual case, and there definitely isn't a blanket rule.
This short term fix of a cortisone injection is simply that; a potential short term solution.
Longer term it doesn't work in most people, though it does for some, and we’ve definitely had people get full resolution from a cortisone injection into their shoulder bursa.
We’ve also seen a large number get short term, or no relief. These people have gone on to gain success with a targeted strengthening regime.
Hence, this is why a targeted strengthening regime is often the best solution for stubborn shoulder pain.