Subacromial Bursitis Made Easy
Understanding Shoulder Bursitis
The subacromial bursa is a thin, sac-like structure located just under the acromioclavicular, or AC, shoulder joint. It acts as a lubricating buffer between the rotator cuff, undersurface of the lateral clavicle and scapular acromion process.
Specifically, the bursa’s main function is to reduce friction in the upper layers of the rotator cuff and humeral head during shoulder motion. As a thin, fluid-filled sac, similar to a slim water balloon, it is quite efficient at specifically doing so with respect to the head of the humerus, long-head of the biceps tendon and the (all-important) rotator cuff. Given the level of motion and stress associated with the shoulder joint, the subacromial bursa certainly faces a trying task every single day. However, this does not even involve direct contact with the shoulder girdle.
Rotator cuff tendonitis and shoulder impingement syndrome are other conditions commonly associated with chronic subacromial bursitis. Additionally, it is not unusual for a chronic rotator cuff injury that alters shoulder joint mechanics to result in subacromial bursa inflammation. It is therefore extremely important to assess for any additional upper extremity or torso imbalances/injuries that require treatment when an athlete presents with a bursitis involving the shoulder.
Signs & Symptoms of Subacromial Bursitis
- Generalized stiffness of the shoulder joint, mostly on the top and front of the shoulder
- Symptom escalation generally associated with either a direct blow to the front of the shoulder joint or increased shoulder use, usually involving overhead-type activities
- A sense of weakness or loss of strength with activities involving the shoulder
- Localized puffiness or a pocket of swelling in the upper-front area of the shoulder, just below the AC joint, which becomes more evident when the arm is extended at the shoulder
- Weakness with active shoulder elevation and abduction
Professional Treatment for Subacromial Bursitis
- Eliminate all routines that contributed to the bursitis. This can include excessive overhead activities, trauma or contact to the shoulder, weight training above shoulder level, painful motion during activities of daily living (ADLs) or carrying heavy objects like luggage with the affected shoulder.
- Consistently ice the front, top and back of the shoulder.
- Utilize available therapy modalities to decrease pain and swelling.
- Do easy pendulum swings with no more than 5 pounds of weight.
- Perform passive and pain-free range of motion (ROM) shoulder joint exercises, to include flexion, abduction, horizontal abduction and external rotation. At the same time, minimize shoulder extension and horizontal adduction motions.
- Employ progressive resistive strengthening of external shoulder rotation, if pain free.
- Avoid sleeping on the affected shoulder if still swollen and/or painful.
Ask the Right Questions Like a Pro
Here’s what smart pro athletes would ask their sports medicine specialist to ensure a fast and safe return to the game they love:
1. Is this an isolated bursitis, or do I need to treat other shoulder issues as well?
2. Is my rotator cuff damaged?
3. What do you believe caused this injury, and how can I avoid these types of injuries in the future?
4. Should I expect future anti-inflammatory injections for this bursa?
Elite Sports Medicine Tips from Mike Ryan
- Looks Can Be Deceiving – Bursitis often looks worse than it feels.
- Get it Right the First Time – Don’t let the lack of initial pain fool you – with the bursa’s proximity to the rotator cuff, seek swift, appropriate treatment to avoid a chronic nightmare.
- Ice, Ice Baby – It’s said time and time again, but the “ice thing” is a key tool to quiet down bursitis and reduce localized swelling.
- Pinpoint the Source – If the reason for bursa swelling is unknown, dig deeper to find out why. Quickly finding the source helps avoid major shoulder complications down the road.
- Avoid the Knife – Some doctors are quick to offer a “simple surgical solution.” Run away quickly and reread this article.