Shoulder Bursitis

What is Shoulder Bursitis?

Bursae are fluid filled sacs that act to reduce friction between bones, tendons and/or muscles surrounding surfaces that are exposed to higher degrees of wear and friction. There are five main bursae that are located around the shoulder that help to provide lubrication and reduce friction during the wide range of movements that the shoulder can do. These include the subacromial-subdeltoid bursa, subscapular recess, subcoracoid bursa, coracoclavicular bursa and supra-acromial bursa.

Figure 1. Anatomy of the shoulder with subdeltoid and subacromial bursa locations shown. Note the subacromial bursa lying underneath a bony prominence (acromion) and covering a tendon of a muscle (supraspinatus). Also note the sub-deltoid bursa that closely associates with the sub-acromial bursa and lies between a large muscle (deltoid) and the head of the humeral bone and rotator cuff muscles.

Subacromial-Subdeltoid Bursitis:

The subacromial bursa is located beneath the bony prominence (acromion) at the top of the shoulder and acts to reduce friction between the acromion and tendon of supraspinatus tendon. Usually, the space that lies between the acromion and subacromial bursa is only 1 – 1.5cm in height and is called the subacromial space. The subdeltoid portion of the bursa lies beneath a large muscle called the deltoid which plays a major role in arm movements and shoulder stability. The subdeltoid bursa is so closely associated with the subacromial bursa general inflammation will affect both bursa and thus, they are grouped together.

Subacromial bursitis is the most common form of bursitis that can occur in the shoulder and will commonly cause shoulder pain. Bursitis, regardless of its location, is an inflammatory condition which can have a variety of causes. Subacromial bursitis will often be caused by repetitive overhead activities / overuse, direct trauma (fall), impingement within the subacromial space, infection and autoimmune disease (rheumatoid arthritis).

Typically, individuals who are performing more overhead activities such as athletes (baseball, javelin, cricket etc.) and manual labourers will be at a higher risk of developing shoulder bursits. As people grow older, natural age-related changes can result in the subacromial space becoming smaller and lead to greater impingement within the shoulder joint. Therefore, shoulder bursitis tends to be more common among the older population.

Certain shoulder movements such as repetitive overhead activities, prolonged arm elevation, repetitive shoulder rotation activities, excessive pushing or pulling or sleeping on the affected shoulder, all place compressive forces on the subacromial bursa resulting in irritation, pain and inflammation. Other movements such as abducting the arm (lifting the arm out sideways) can also provide a compressive force that may cause inflammation of the bursa.

Patients that suffer from shoulder bursitis usually experience excessive warmth at the site of the inflamed bursa. They often complain of a great deal of tenderness, pain, and fever. The swelling and redness may spread away from the affected site and go up or down the arm.

Condition Management

Management for Shoulder Bursitis can come through a variety of mediums. Chiropractic and physiotherapy care is the most preferred first line treatment. According to Abdulla et al (2020) supervised progressive shoulder exercises alone or combined with home-based shoulder exercises provided effective short and long-term management for shoulder bursitis. The supervised shoulder therapy and exercise program was provided over 8 weeks and saw improvements across pain (at rest and during movement), quality of life and muscle strength. Pieters et al (2020) also found that these types of shoulder exercise programs provide the same long-term outcomes when compared as a treatment to shoulder decompression surgery for shoulder bursitis / impingement.

Exercises prescribed for shoulder bursitis involve improvement of the muscles that play a role in scapula and shoulder movement. Overall, this aims to improve shoulder stabilising muscles like the rotator cuff as well as scapular stabilising muscles such as Serratus Anterior to improve the quality of movement and reduce impingement around the shoulder. Addition of these scapular stabilising exercises to conventional shoulder strengthening exercises was demonstrated by Shah et al (2014) through a short 4-week program and showed significant improvement in pain and functional status for shoulder bursitis and impingement compared to conventional exercise alone.

In addition to exercise therapy as a treatment for shoulder bursitis, massage and taping have been investigated as adjunct therapies. Haik et al (2016) demonstrated the benefits of massage (manual therapy) in addition to exercise as management of shoulder bursitis. When massage and exercise was compared to exercise alone there was a greater reduction in pain and improvement in function in the short-term. Similarly, Miller and Osmotherly (2009) showed that scapula taping provided a significant reduction in pain during provocative movements for a 2-week period.

Thus, according to current research shoulder bursitis is best managed through chiropractic or physiotherapy care. Exercises should include progressive shoulder strengthening that focuses not only on rotator cuff but also scapula stabilizing muscles. Massage and taping may be used throughout recovery to provide short term pain relief. Finally, completion of at home exercises will enhance the improvements provided by chiropractic and physiotherapy care. This line of care will improve muscle control throughout all shoulder movements to best reduce impingement within the subacromial space and relieve compressing forces from causing inflammation on the subacromial-subdeltoid bursa.

Here at Precision Health we offer services such as Chiropractic care and massage therapy which can aid in your recovery from Shoulder Bursitis. Call (02) 9639 7337 or visit our website to book an appointment now!

References

Abdulla, S.Y. et al. (2015) ‘Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMA) collaboration’, Manual Therapy, 20(5), pp. 646–656. doi:10.1016/j.math.2015.03.013.

Faruqi, T. and Rizvi, T.J. (2023) Subacromial bursitis, Subacromial Bursitis. Available at: https://www.ncbi.nlm.nih.gov/books/NBK541096/ (Accessed: 25 August 2025).

Haik, M.N. et al. (2016) ‘Effectiveness of physical therapy treatment of clearly defined subacromial pain: A systematic review of Randomised Controlled Trials’, British Journal of Sports Medicine, 50(18), pp. 1124–1134. doi:10.1136/bjsports-2015-095771.

Miller, P. and Osmotherly, P. (2009) ‘Does scapula taping facilitate recovery for shoulder impingement symptoms? A pilot randomized controlled trial’, Journal of Manual & Manipulative Therapy, 17(1). doi:10.1179/jmt.2009.17.1.6e.

Pieters, L. et al. (2020) ‘An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain’, Journal of Orthopaedic & Sports Physical Therapy, 50(3), pp. 131–141. doi:10.2519/jospt.2020.8498.

Shah, M., Sutaria, J. and Khant, A. (2014) ‘EFFECTIVENESS OF SCAPULAR STABILITY EXERCISES IN THE PATIENT WITH THE SHOULDER IMPINGEMENT SYNDROME’, Indian Journal of Physical Therapy, 2(1), pp. 79–84.

Shoulder bursitis – physiopedia (no date) Shoulder Bursitis. Available at: https://www.physio-pedia.com/Shoulder_Bursitis (Accessed: 25 August 2025).

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