Subacromial Bursitis

 

Introduction to Subacromial Bursitis

Subacromial bursitis is a common condition affecting the shoulder, characterised by inflammation of the bursa located below the acromion. In layman’s terms, Subacromial bursitis is a name given to inflammation around the tendons encircling the shoulder joint which make up the rotator cuff. The tendons produce fine movement of the shoulder and stabilise the joint to allow the main powerhouse of the shoulder (the deltoid muscle) to produce the main force. Inflammation of the tendons or the lining of the tendons (the bursa) can lead to pain usually felt down the side of the arm and worse with movement, particularly in the painful arc position from waist height to above shoulder height.

This condition can lead to significant shoulder pain and discomfort, particularly during overhead activities. At Glenelg Orthopaedics, we specialise in diagnosing and treating this condition, ensuring our patients in Adelaide and surrounding areas receive specialist care.

Symptoms of Subacromial Bursitis

Common Signs and Symptoms

Patients with subacromial bursitis often report a sharp, aching pain in the shoulder, especially when lifting the arm above the head or during night-time. The pain is felt in the top of the shoulder radiating down the side of the arm worse with motion, often worse when sleeping and with use of the arm above chest height or when outstretched.

When to Seek Medical Advice

If you’re experiencing persistent shoulder pain that interferes with daily activities or rest, which has not responded to physiotherapy, then it is worth seeking medical advice. We can offer assessment, and investigations to determine if there is other causes such as AC joint arthritis, frozen shoulder, rotator cuff tears or arthritis, and then direct and offer the most appropriate treatment.

Anatomy of the area around the shoulder affected withsubacromial bursitis

Causes and Risk Factors

Common Causes

Subacromial bursitis often results from repetitive overhead activities, leading to irritation and inflammation of the bursa. Age-related degeneration of the shoulder tendons can also contribute to this condition.

Risk Factors for Developing Subacromial Bursitis

Factors increasing the risk of developing subacromial bursitis include:

  • Age: Incidence increases with age due to wear and tear.
  • Occupation: Jobs requiring repetitive overhead movements.
  • Sports: Activities like tennis or swimming that stress the shoulder.
  • Previous Shoulder Injuries: History of shoulder injuries can predispose to bursitis.
  • Smoking: this damages the tendon collagen and leads to inflammation
  • Family history of shoulder issues.

Diagnosing Subacromial Bursitis

Diagnostic Procedures

Diagnosis typically involves a physical examination and imaging tests like ultrasound or MRI. These tests help in assessing the extent of inflammation and ruling out other conditions like rotator cuff tears.

What to Expect During Your Consultation

During your consultation at Glenelg Orthopaedics, we’ll conduct a thorough examination, discuss your symptoms, and review your medical history. We may perform specific movements to assess pain and range of motion in your shoulder.

Treatment Options

Non-Surgical Treatments

Most cases of subacromial bursitis respond well to non-surgical treatments, including:

  • Rest and activity modification to reduce stress on the shoulder.
  • Physiotherapy exercises to strengthen the rotator cuff muscles.
  • Pain relief medications and anti-inflammatory drugs.
  • Ultrasound-guided corticosteroid injections for reducing inflammation.

Surgical Treatments

In severe cases where non-surgical treatments are ineffective, surgery may be considered. Procedures like arthroscopic bursectomy or acromioplasty can provide relief by removing inflamed tissue or creating more space for shoulder movements.In cases of considerable continuing pain, surgery could be considered. 

If there is a tear of a tendon of the rotator cuff, this is repaired at the same time. Dr Gavin Nimon performs the surgery arthroscopically (arthroscopic minimally invasive shoulder surgery), which involves an inspection of both the inside of the shoulder joint, then the subacromial bursa and treating it as required.  

On occasions, the labrum may be torn  or the long head of the biceps tendon may be inflamed or partially torn. The labrum can be repaired if required or the biceps tendon can either be treated. At the time of surgery, an arthritic acromio-clavicular (AC) joint can also be cleaned out.

For cases of purely subacromial bursitis, there has been a large study published in the Lancet which documented no difference between surgery and nonoperative measures, however the Australian Shoulder and Elbow society have released a statement which concludes that in those patients which have not responded to nonoperative measures, that there may be a role for surgical intervention.

Rehabilitation and Physiotherapy

Post-treatment, rehabilitation plays a crucial role in recovery. Our physiotherapy program focuses on restoring shoulder strength and flexibility, gradually returning you to your normal activities.

Prevention and Management

Lifestyle Changes and Preventive Measures

Preventive measures include:

  • Regular shoulder exercises to maintain strength and flexibility.
  • Proper techniques in sports and occupational activities.
  • Avoiding repetitive overhead movements.
  • Avoiding smoking ( of any substance), as this leads to deterioration in the tendons and subsequent subacromial bursitis.
Image of arthhroscopy of the shoulder for subacromial bursitis

Shoulder Arthroscopy

  1. Images purchased from Shutterstock (enhanced licence)
  2. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial: The Lancet open access .November 20,  2017
  3. Statement from the Shoulder and Elbow Society of Australia (an AOA subspecialty society) to the Medical Observer. December 2017

FAQs About Subacromial Bursitis

In this section, we address common questions about subacromial bursitis, providing you with reliable information to understand and manage your condition better.

Q1: Can subacromial bursitis heal on its own?

A: Most cases of subacromial bursitis will improve with time, physiotherapy and on occassions the doctor will try a steroid injection for subacromial bursitis. It  can be helped by avoiding the painful position .

Q2: How long does it take to recover from surgery for subacromial bursitis?

A: Recovery time varies depending on the severity of the condition, but most patients will require post-operative physiotherapy and would expect an improvement over a 2 to 6-month period, but full recovery can take up to a full year. Many patients have a much quicker recovery however.

Q3: Are there any exercises I can do at home for subacromial bursitis?

A: Yes, gentle stretching and strengthening exercises can be beneficial, but it’s important to consult with a physiotherapist for a tailored exercise program.

Q4: Is surgery necessary for subacromial bursitis?

A: Surgery is generally considered only when non-surgical treatments have not provided relief. Your orthopaedic surgeon will discuss the best options for your specific condition.

Q5: Can subacromial bursitis recur after treatment?

A: Recurrence is possible, but not common. Recurrence of symptoms may relate to other causes of shoulder pain, ie development of a rotator cuff tear or arthritis of the shoulder or development of referred pain from an arthritic neck..

Contact Us for Consultation

At Glenelg Orthopaedics, we understand the impact of shoulder pain on your quality of life. Dr Gavin Nimon is committed to providing Affordable and Quality Care for subacromial bursitis.

From initial consultation to treatment and rehabilitation, he will support you every step of the way.