In short
Shoulder bursitis is irritation of the fluid-filled cushion that sits above the rotator cuff tendons. It causes pain on the outside of the shoulder when you lift your arm or lie on that side. It usually settles with relative rest and a graded exercise program. An injection can ease severe pain for a while. Surgery to make more room in the shoulder has been shown to work no better than a placebo operation.
On this page
What is shoulder bursitis?
A bursa is a small, fluid-filled cushion that protects a tendon where it slides over bone. When a bursa becomes irritated or inflamed, it swells with fluid, and that swelling can be painful and limit movement.1
The bursa most often involved in the shoulder sits between the rotator cuff tendons and the bony arch at the top of the shoulder. Doctors call it the subacromial bursa, so the condition is also known as subacromial bursitis. It can cause pain when you lift your arm above your head.1
Shoulder bursitis symptoms
- Pain on the top and outer side of the shoulder, often spreading down the upper arm
- Pain when lifting your arm out to the side or overhead, reaching behind your back or getting dressed
- Pain lying on that shoulder at night
- Tenderness, and sometimes a feeling of weakness because movement hurts1
Pain that keeps coming back?
Talk it through with an Australian doctor online. No referral needed.
What causes it?
Bursitis is commonly caused by overuse, especially repeating the same movement often, at work, in sport or in hobbies such as gardening. It can also follow an injury, or occur with conditions such as gout and rheumatoid arthritis.1 Occasionally a bursa becomes infected.2
Bursitis, rotator cuff or impingement?
These labels overlap a great deal. The bursa and the rotator cuff tendons lie against each other, and it is usually not possible to say which one the pain is coming from. Many clinicians now use one umbrella term, rotator cuff related shoulder pain, which takes in bursitis, tendon problems and what used to be called impingement.3 The treatment is much the same. See shoulder pain.
What an ultrasound can and can’t tell you
An ultrasound report that says “bursitis” or “bursal thickening” is not proof that the bursa is the cause of your pain. In a study that scanned the shoulders of 51 men aged 40 to 70 who had no shoulder symptoms, 78 per cent had a thickened bursa, and 96 per cent had at least one abnormal finding.4
Scans are useful for ruling other things out. On their own, they are a poor guide to what hurts.
How is shoulder bursitis treated?
Ease off, but keep moving
Avoid the activities that bring on the pain for a while, and use ice packs.1 Don’t stop using the arm altogether. A shoulder that is kept still can stiffen. See frozen shoulder.
Exercise
A physiotherapist can give you a graded program to strengthen the muscles around the shoulder. A review of the research concluded that a well-designed exercise program gives results at least as good as surgery for this group of conditions.3
Exercise is not a quick fix. In the best-quality trial in a Cochrane review, people who had manual therapy and exercise improved only a little more than those who had a placebo treatment over 22 weeks. The difference was clear for function and uncertain for pain.5 Both groups got better, which fits with the condition tending to settle over months.
Injection
For severe pain, your doctor may suggest an injection into or around the bursa.1 It can give you a window of relief in which to get the shoulder moving again.
Surgery
The traditional operation, called subacromial decompression, shaves bone from the arch above the tendons to give them more room. It has now been tested against placebo surgery:
- In a British trial of 313 people, those who had the real operation did no better at six months than those who had keyhole surgery in which nothing was removed.6
- A Cochrane review of eight trials reached the same conclusion.7
- An international guideline panel now makes a strong recommendation against this surgery for people with this kind of shoulder pain, because it offers no important benefit and carries some risk.8
How long does shoulder bursitis last?
It varies. Mild cases settle in a few weeks once the aggravating activity stops. Longer-standing pain often takes several months of steady rehabilitation.
When to see a doctor
- Shoulder pain or stiffness that is affecting your daily life1
- Pain that hasn’t started to improve after a couple of weeks
- Sudden weakness, or you can’t lift your arm after a fall or injury
- A shoulder that is hot, red and swollen, or you have a fever. This could be an infection and needs urgent attention2
- Shoulder pain with chest pain or shortness of breath. Call 000
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- healthdirect. Bursitis.
- Better Health Channel (Victorian Government). Bursitis.
- Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 2016;23:57-68.
- Girish G, Lobo LG, Jacobson JA, et al. Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol. 2011;197(4):W713-9.
- Page MJ, Green S, McBain B, et al. Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev. 2016;2016(6):CD012224.
- Beard DJ, Rees JL, Cook JA, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018;391(10118):329-338.
- Karjalainen TV, Jain NB, Page CM, et al. Subacromial decompression surgery for rotator cuff disease. Cochrane Database Syst Rev. 2019;1(1):CD005619.
- Vandvik PO, Lähdeoja T, Ardern C, et al. Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline. BMJ. 2019;364:l294.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.