The shoulder is one of the largest and most complex joints in the body. The shoulder joint is formed where the humerus (upper arm bone) fits in the scapula (shoulder blade), like a ball-and-socket.
The subacromial bursa is a structure that lies between the upper surface of the rotator cuff and the undersurface of the acromion. The bursa, in fact, is a potential space that lies between two surfaces that move. It is usually formed by two smooth surfaces with a thin film of fluid between them, and it allows for movement to occur by providing gliding surfaces that can move over each other.
The subacromial bursa is mainly affected by bursitis (subacromial bursitis) – it acts as a cushion to allow the supraspinatus tendon to slide smoothly over the neighboring soft tissues and bone. Due to its location and relationship to the acromion and supraspinatus, the subacromial bursa tends to be most at risk of being impinged or irritated.
Subacromial bursitis is often connected to two other conditions, which are impingement syndrome and rotator cuff tendonitis. For this reason, it is always recommended to address and treat shoulder pain as soon as possible so that the problem does not worsen.
A healthy subacromial bursa is typically about the size of a small plum but can swell to the size of an orange when bursitis sets in. This is what creates soft tissue damage or possible impingement in the shoulder joint.
Causes & Symptoms of Subacromial Bursitis
Subacromial bursitis can have one or a combination of causes, some of which include:
Falling or banging the shoulder on a hard surface (steel or concrete) could cause the bursa to fill with blood and the bursa’s lining to become inflamed. Even though the body reabsorbs the blood, the bursa’s lining may remain inflamed, causing bursitis symptoms. This is known as ‘traumatic bursitis’.
Bursitis is often caused by frequent mini-traumas, which may cause the same problems as a single, more serious trauma. People who must lift their arms overhead for work or sports are susceptible to developing subacromial bursitis over time.
Infection of a bursa
An infection of the bursa is referred to as septic bursitis. Certain medical conditions and medications suppress people’s immune systems and make them more prone to infection. For instance, people with HIV / AIDS, lupus, or cancer may be more likely to develop septic bursitis.
Generally, the shoulder’s bursae and other soft tissue can become irritated by bone spurs (osteophytes) that grow on the underside of the acromion. Calcium deposits (tiny collections of calcium that are often small and soft but can grow and harden) can also cause irritation.
Studies have shown that most patients experience subacromial bursitis symptoms a couple of days after vaccination (for example, the flu vaccination). Doctors also theorize that subacromial bursitis can occur due to nearby inflammation resulting from the injected material or because the injection needle disturbed the shoulder’s bursa.
If you are suffering from inflammation of the subacromial bursa, you may be experiencing the following symptoms:
- Shoulder weakness – As subacromial bursitis worsens, you may avoid using the shoulder, causing the muscles to weaken.
- Tenderness – The outer shoulder may be tender and sensitive to the touch. Lying down or putting pressure on the affected side may increase the pain.
- Difficulty sleeping – You may feel pain that can cause a lack of sleep during nighttime, especially while lying on the affected shoulder.
- Pain when lifting – such as lifting overhead or other movements in the shoulder.
- Pain that worsens after an activity – The pain may increase in intensity after performing an activity that requires repetitive use of the shoulder movements, such as painting or throwing a ball.
- Fever – Experiencing a fever is possible if you are suffering from septic bursitis.
Who gets Subacromial Bursitis?
Subacromial bursitis can be the result of several possible factors, including:
- Age – While subacromial bursitis can affect anyone of all ages, older patients 50 and older have an increased chance of developing the condition.
- Poor posture – Patients who constantly hunch their shoulders decrease the space between the acromion and the glenohumeral joint, making it more likely that the soft tissue in between will suddenly become squeezed and irritated.
- History of symptoms linked to shoulder bursitis – People who have had bursitis in the past are prone to developing it once again.
Moreover, if you are suffering or have suffered other shoulder problems such as rotator cuff tendonitis, bone spurs, a hooked acromion, and / or impingement syndrome, your subacromial bursa is at risk of becoming inflamed. These conditions can irritate the bursa which will result in bursitis if left untreated.
Also, repetitive overhead shoulder movements, especially if they are weight-bearing, may cause fatigue or general weakness in the shoulder muscles and tendons. As a result, your shoulder joint could become misaligned, causing more pressure on the subacromial bursa. Classification of the bursa sac may also cause inflammation within the bursa.
How Does Subacromial Bursitis Affect You? How Serious is it?
Over time, subacromial bursitis can be managed with non-surgical self-care, although it may take you several weeks or even months to completely recover. If this condition is left untreated, subacromial bursitis complications could arise (with a chance of interfering with your daily activities) including:
- Increased pain
- Difficulty moving the joint
- Limited range of motion
- Shoulder tendonitis (inflammation of the shoulder tendon)
In severe cases, if you have infectious bursitis, the infection could lead to sepsis.
Sepsis occurs when an infection you already have triggered a chain reaction throughout your body. Bacterial infections are the most common cause, but other types of infections may also cause sepsis. Another life-threatening problem that can sepsis can cause is septic shock, where your blood pressure drops to a dangerous level and multiple organs can fail.
Recommended Treatment & Rehabilitation for Subacromial Bursitis
If you’re having symptoms of subacromial bursitis, it is highly recommended to visit a doctor as he or she will perform a thorough physical examination by bending to examine your shoulder.
You will also be checked to see where you are feeling pain and tenderness. Your doctor may test your range of motion by asking you to move your arm in certain directions. Afterwards, he / she will test the strength of your shoulder joint by asking you to press against their hand.
Once your doctor has finished performing the physical exam, additional imaging tests will be ordered to help rule out other conditions associated with your condition. An X-ray may be ordered first to see if you have a bone spur.
An ultrasound or magnetic resonance imaging (MRI) scan will also be ordered to precisely check for inflammation in your rotator cuff and signs of any tearing. It is important to get proper treatment for subacromial bursitis as soon as it occurs.
Once a diagnosis has been completed, physiotherapy may be further advised. A physiotherapist will work with you by designing a special treatment program specific to your condition and goals. Therefore, this treatment will include the following:
Reduce pain and swelling
If repetitive activities have caused subacromial bursitis, your physiotherapist will help you understand how to avoid or modify the activities to allow healing to begin. Your therapist may also use several types of treatments and technologies to manage and reduce your pain and swelling, including ice, heat, ultrasound, taping, and hands-on therapy, such as specialized massage.
Your physiotherapist will choose specific activities and treatments to help restore regular movement in the shoulder and arm. These might begin with passive motions that he or she performs for you to gently move your shoulder joint, and progress to active exercises and stretches that you can do at home.
Improve your posture
If posture problems are found to be related to your condition, your physiotherapist will work with you to help improve your posture to help alleviate your pain and prevent future recurrence.
Improve your flexibility
Your physiotherapist will determine if any shoulder, arm, chest, or neck muscles are tight, start helping you to stretch them, and teach you how to stretch them.
Improve your strength
Subacromial bursitis is commonly related to weak, injured, or uncoordinated shoulder muscles. Certain exercises will aid healing at each stage of recovery; your physiotherapist will decide which correct exercise to teach you and which equipment to use to steadily restore your strength and agility.
Improve your endurance
Regaining your muscular endurance in the shoulder is important after an injury. Your physiotherapist will teach you a set of exercises to improve your muscular endurance, so you can return to your normal activities. Cardio-exercise equipment may be used, such as treadmills or stationary bicycles.
Return to your activities
Your physiotherapist will discuss your activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest and most effective way possible.
Performing the best exercise for subacromial bursitis is important during recovery since these muscles are essential for everyday function. Here are some exercises for you to try:
Isometric shoulder external rotation
Standing in a doorway with your elbow bent at a 90-degree angle and the back of your wrist pressing against the door frame, try to press your hand outward into the door frame. Hold this position for about 5 seconds, then repeat the exercise 3 times a day.
Isometric shoulder internal rotation
Standing in a doorway with your elbow bent at a 90-degree angle and the front of your wrist pressing against the door frame, try to press your palm into the door frame. Hold for 5 seconds, then do 3 more sets of 10 repetitions a day.
Stand with your arms at your sides and with your elbows straight. Slowly raise your arms to eye level. As you raise your arms, they should be spread apart so that they are only slightly in front of your body (at about a 30-degree angle to the front of your body). Point your thumbs toward the ceiling. Hold this stretch for 2 seconds and lower your arms slowly before repeating the exercise with 3 sets of 10 repetitions.
Side-lying external rotation
Lie on one side with your top arm at your side and your elbow bent to 90 degrees. Keep your elbow against your side, raise your forearm and hold for 2 seconds. Slowly lower your arm, then do 3 more sets of 10 repetitions.
Alternative & Homeopathic Treatment for Subacromial Bursitis
There are several ways for you to alleviate your subacromial bursa. The key to this process is understanding that some movements and exercises can be very helpful, while others can harm your shoulder. Here are some homeopathic treatments to help relieve symptoms linked to subacromial bursitis:
Avoid activities that will aggravate and inflame the subacromial bursa, such as throwing, lifting, pushing, and pulling.
Gently massaging your shoulder will help alleviate stress and tension in the surrounding muscles, while also improving blood circulation and reducing swelling in the process, all of which can reduce your pain levels.
Pain-relieving creams, sprays, and gels are applied directly to the skin over the painful joint. Topical medications may treat the inflammation that causes pain, distract from the pain, or reduce and eliminate pain.
Applying ice reduces blood flow, which will decrease inflammation and swelling, and alleviate pain in the process; cold therapy is recommended immediately after pain strikes, and ice packs should be applied for 15-20 minutes, up to 5 times a day.
Applying heat to a painful shoulder increases blood flow and brings in oxygen and nutrients to the area, which will accelerate the healing process and alleviate pain; this is recommended a few days after the onset of pain and can be accomplished with an added hot shower directly on the shoulder or a hot pack applied to the affected area for 15-20 minutes a day.
Non-steroidal anti-inflammatory medications (NSAIDs)
Some patients with mild shoulder tendonitis can experience relief with pain medications that do not require a prescription, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen; NSAIDs may alleviate pain by reducing inflammation.