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What is Subacromial Bursitis ?

Subacromial bursitis is a common cause of shoulder pain that results from the inflammation of the subacromial bursa.

What is a Bursa?

A bursa is a small, fluid-filled sac that acts as a cushion between bones, muscles, tendons, and skin. Its primary function is to reduce friction and allow smooth movement between these structures, especially during movement of a joint.

The Subacromial Bursa

The subacromial bursa is located in the shoulder, specifically beneath the acromion (the bony tip of the shoulder blade) and above the rotator cuff tendons. When functioning normally, it allows the rotator cuff tendons to glide smoothly under the acromion as you move your arm.

What is Subacromial Bursitis?

Subacromial bursitis occurs when this specific bursa becomes inflamed and irritated. This inflammation leads to swelling and increased fluid within the bursa, causing pain and restricted movement in the shoulder.

Causes of Subacromial Bursitis

The inflammation of the subacromial bursa is usually a result of:-

  • Repetitive Overhead Activities: This is the most common cause. Activities that involve repeated arm movements above shoulder level can irritate and inflame the bursa. This is why it’s common in athletes (e.g., swimmers, baseball pitchers, tennis players) and certain occupations (e.g., painters, construction workers, mechanics).
  • Direct Trauma: A fall onto the shoulder or a direct blow to the shoulder can cause the bursa to become inflamed.
  • Overuse or Strain: Sudden increases in activity level or intense shoulder use without proper conditioning.
  • Shoulder Impingement: This is closely related. When the space under the acromion becomes narrowed (due to bone spurs, thickened tendons, or poor posture), the rotator cuff tendons and the bursa can get “pinched” or “impinged” during arm movement, leading to inflammation. Subacromial bursitis often occurs with rotator cuff tendinitis (inflammation of the rotator cuff tendons) as part of a larger condition called shoulder impingement syndrome.
  • Poor Posture: Slouching or rounded shoulders can narrow the subacromial space, increasing the risk of impingement and bursitis.
Symptoms of Subacromial Bursitis

The symptoms typically include:-

  • Pain in the shoulder: This is often the primary symptom. The pain is usually felt on the outer or front aspect of the shoulder and may radiate down the arm.
  • Pain with overhead movements: Activities like reaching up, lifting the arm above 90 degrees, or even putting on a coat can exacerbate the pain.
  • Pain at night: Especially when lying on the affected shoulder, which can disrupt sleep.
  • Tenderness to touch: The area over the subacromial bursa (just under the tip of the shoulder) may be painful when pressed.
  • Stiffness: A limited range of motion in the shoulder, making it difficult to move the arm freely.
  • Swelling: While sometimes visible, often the swelling is deeper and not overtly obvious.
  • Warmth or Redness: In some cases, especially if there’s infection (septic bursitis), the area might feel warm and appear red. This requires urgent medical attention.
Diagnosis
  • X-rays: Primarily to rule out bone spurs or arthritis, not directly to visualize bursitis.
  • Ultrasound: Can clearly show inflammation and fluid within the bursa.
  • MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, including the bursa and rotator cuff tendons, allowing for assessment of both conditions.
Treatment

Treatment for subacromial bursitis typically focuses on reducing inflammation, relieving pain, and restoring normal shoulder function

  • Ice Application: Apply ice packs to the affected area for 15-20 minutes several times a day, especially in the acute phase, to reduce pain and swelling.
  • Physical Therapy: This is a crucial component of recovery and prevention of recurrence. A physical therapist will design a program to:-
    • Reduce pain and inflammation.
    • Restore full, pain-free range of motion.
    • Strengthen the rotator cuff muscles and scapular stabilizers.
    • Improve posture and shoulder mechanics to reduce impingement.
    • Gradually return to activity.
  • Heat (after acute inflammation): Once the initial acute inflammation subsides, gentle heat can sometimes be applied to help relax muscles and promote blood flow.

Prevention-

  • Proper Warm-up and Cool-down: Before and after physical activity.
  • Gradual Increase in Activity: Avoid sudden increases in intensity or duration of activities involving overhead movements.
  • Proper Technique: In sports and work-related tasks, ensure correct biomechanics to minimize stress on the shoulder.
  • Strengthening and Flexibility: Maintain strong rotator cuff muscles and good shoulder flexibility.
  • Good Posture: Be mindful of posture, especially during prolonged sitting or standing.
  • Ergonomics: Adjust workstations and tools to reduce repetitive strain.

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