Subacromial (shoulder) bursitis is a common reason for shoulder pain and often associated with other shoulder pathology e.g. rotator cuff tendinopathy, subacromial impingement and shoulder instability.
Put simply, bursitis is inflammation of a bursa.
There are approximately 8-12 bursa in and around the shoulder with the subacromial, sub-deltoid, subcoracoid and subscapular bursae being the most commonly irritated and referred to in the literature.
The normal function of the bursae is to act like the oil in the engine of your car; lubricating and protecting moving parts.
Usually we are blissfully unaware of their existence (the oil and the bursa) until black smoke pours out the back of your car or you feel an ache in your shoulder, that sometimes grabs and pinches, often making sleeping at night difficult.
Whilst the subacromial bursa, is considered a major pain generator of the shoulder, it is also proprioceptive and involved in the sensory motor control of the shoulder joint. The normal bursa is filled with free nerve endings, capable of responding at varying speed to a variety of stimuli, for example pain, temperature, stretch and pressure.
The best evidence suggests, that in the inflamed bursa, an increased density of free nerve endings, and pro-inflammatory chemicals (e.g. cytokines & substance P) correlate with increased pain and may have a catabolic (negative) effect on the rotator cuff tendons.
The subacromial bursa is commonly involved in subacromial pain syndromes like subacromial impingement, reactive rotator cuff tendinopathy and rotator cuff tears.
Does Injection Therapy Help?
Sometimes, subacromial bursal injections are required when the bursa is significantly inflamed and irritable.
Hydrocortisone local anaesthetic (HCLA) subacromial injections are designed to be therapeutic and diagnostic. They are not a “silver bullet” but can be very effective in reducing pain and irritability.
Post injection a specific shoulder physiotherapy program which is exercise based is recommended.
Does Shoulder Physiotherapy Provide Long Term Pain Relief?
In my opinion, Yes!…when done right.
The early focus of shoulder rehabilitation should be to decrease the inflammatory response and reduce pain to an acceptable level to better facilitate early physiotherapy intervention.
It is important to note that all shoulder movements will stretch and/or compress the bursa under normal use but once inflamed the bursa may play a significant role in perpetuating shoulder pain and movement dysfunction.
This is where both the science and art of shoulder physiotherapy take place simultaneously.
Pain relief in my experience can happen relatively quickly when using a skilfully combined approach of massage, manual therapy, scapula and shoulder neuromuscular “movement control” retraining and strengthening.
Treating shoulder bursitis is about “doing the right things” consistently so that you get fast and long lasting shoulder pain relief.
There is growing evidence that specific shoulder physiotherapy can reduce the need for expensive, painful and often unreliable shoulder subacromial decompression surgery.
In my opinion, surgery should be your very last resort.