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Sunday, May 24, 2020

Shoulder bursitis by William Dao

What is the injury?

Bursae are fluid-filled sacs that are found in joints all over the body. They are generally situated between bone, tendons, muscles and skin. They act as a cushion to reduce the friction between the tissues that move against each other. Shoulder bursitis is the irritation and inflammation of a bursa in the shoulder. The most commonly irritated bursa in the shoulder is the subacromial bursa. It sits between the tip of the shoulder blade (acromion) and the top of the upper arm bone (humeral head). You will often notice pain at the top/front of the shoulder joint and you will be
troubled by overhead reaching, pushing/pressing or lifting. Pain can be worse at night, especially when sleeping on the affected shoulder.

Image reference

How did I get this injury?

There are several causes for a shoulder bursitis. These may include:

– A. Trauma: a once off incident/accident injuring your shoulder. An example would be falling onto the shoulder or elbow causing an upward force into the shoulder.

 

– B. Overload/overuse/microtrauma: a sudden increase/change in activity or repetition of certain movements with the arm/shoulder resulting in overuse of the muscles around the shoulder joint leading to poor control of the shoulder joint complex and hence pressure onto the subacromial bursa. An example would be repeated throwing, returning to tennis from a long break or painting the ceiling.

 

– C. Secondary to other injuries: Subacromial bursitis often occurs alongside other shoulder injuries, such as; Rotator cuff injury (poor shoulder stability or control), Subacromial impingement ,  Frozen shoulder and arthritis.

– D. Anatomical variation: a hooked or larger acromion which increases pressure onto the subacromial bursa through a subacromial impingement.

– E. Inflamed shoulder joint: from arthritis, gout or post-surgery

 

How long will it take to Fix?

Mild irritation of the Bursa from a sudden incident has the potential to settle within 1-2 weeks if you are sensible and refrain from irritating it. However, this is rare, as day-to-day activities can often cause further irritation; activities as simple as sleeping on the affected shoulder, putting a shirt or jacket on, washing/combing your hair, “rounded shoulders” posture and the list goes on. Therefore, understanding the problem and knowing what to do and what not to do is crucial in fixing your bursitis.

Overuse/overload type injuries often take longer, there should be appreciable improvements between 4-6 weeks of doing the right things. However, if your bursitis is a consequence or secondary to another shoulder problem then it could take much longer. As a general rule, the earlier we are able to the address the pain and regain pain-free range of movement of the shoulder then the quicker the recover. We will also need to address the cause of the bursitis, whether that be posture related, overuse related, poor mechanics related etc. Improving strength and control of the shoulder to withstand the forces required for the task at hand is crucial to long term success. Strength gains take a minimum of 6 weeks to kick in, so 12 weeks is generally a good guide for return to sports.

In severe cases, you may need the input of Specialist Doctors for injections and/or surgery. The goal of injections to the bursa are primarily to reduce pain to allow you to continue with Physiotherapy. Physiotherapy is also very important post-operatively if surgery is required.

 

 

What do I need to do to Fix it?

Evidence shows that specific and targeted strengthening is the most successful management for a long-term fix to shoulder bursitis. However, this does not mean that you should commence doing a bunch of strengthening exercises for the shoulder if you find out that you have a Shoulder Bursitis. Firstly, during the early phase of developing shoulder bursitis, people often notice the issue because of an onset of pain. This pain must be managed and a certain amount of pain-free and well controlled movement must be achieved prior to introducing a myriad of strengthening exercises for the shoulder. Secondly, it is not just general shoulder strengthening exercises that should be done; they should be specific and targeted based on the physical examination of your Physio and also dependent on what activity or sports you need to return to.

The shoulder joint is a joint that does NOT follow the “no pain, no gain” rule. If you have pain in the shoulder, you should not push through it because it can prolong the problem or potentially make it worse. Therefore, your Physio will first look at addressing the pain. This may involve a combination of hands on treatment techniques, taping, dry needling/acupuncture, posture correction and simple mobility exercises.

Here are some exercises you may try to begin with:

1. Thoracic spine – bow and arrow stretch 

2. Scapula setting against resistance band (light band)-

3. Low rows with band resistance (light band)- focus on drawing arms back in line with the
body, draw shoulder blades together and not allow them to round forwards.

If you have any further questions on Shoulder bursitis or any of our other blogs then please email us at reception@fixphysio.com.au or come and see us at Fix Physio Sydney in Sydney CBD www.fixphysio.com.au/booking Do not let this problem linger. Shoulder pain can be very stubborn.

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