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Shoulder Pain

Shoulder Bursitis

The bursa refers to a water-like structure found in various locations in the body, it prevents friction between areas which are compressed. They are highly innervated structures which are extremely painful if they become symptomatic. Bursitis in the shoulder refers to a pathologic inflammation of the sub-acromial bursa, often inflamed due to an injury. The common mechanism of this injury would be a direct fall onto the shoulder. This will lead to immediate pain which over the hours following will limit the range of movement due to significant discomfort.

A person with a typical shoulder bursitis will complain of aching pain to the shoulder with sharp pain during arm elevation. S/he will not be able to lie on the affected side and may report waking up at night due to rolling on the side. The pain will be difficult to localise and may be felt around the shoulder. There will be a typical mechanism of injury with a direct trauma on the shoulder. However, it is important to mention that a bursitis may have a non-traumatic cause that has developed by a different pathology, this will not be the typical case for a cyclist.

Examination will reveal pain and difficulty elevating the arm. There will not be any underlying shoulder weakness unless this is due to pain. Functional daily tasks may become difficult because of the inability to use the shoulder as previously. Specific assessment manoeuvres will help guide the physiotherapist towards the diagnosis, however specific radiology with ultrasound may be used to rule in the bursitis and exclude other tissue damage.

Management:

The management of the shoulder bursitis is commonly conservative with good outcomes. This is achieved with ice, anti-inflammatory medication, and activity modification. In cases of severe bursitis a corticosteroid injection may be used directly into the bursa. This has great outcomes and will be used in a shoulder that has not responded to conservative management.

Strand House, 169 Richmond Rd, Kingston upon Thames KT2 5DA 020 8546 6464