The shoulder joint is a fascinating study of design and mechanics. When healthy, it allows for significant range of motion through three degrees of freedom – making it one of the most mobile joints in the body. This freedom of mobility is supplied by intricate bony structures and interdependent soft tissue systems. Unfortunately, mobility can come at a cost and the joint is susceptible to a range of common conditions including, but not limited to, arthritis, frozen shoulder (adhesive capsulitis), instability, tendinopathies and bursitis. This blog will focus specifically on subacromial bursitis.
To get an understanding of what is going on let’s study some basic anatomy. The shoulder is comprised of three bones – the humerus (upper arm), scapula (shoulder blade) and clavicle (collar bone). These bones are attached via several co-dependent tendons, ligaments and muscles. Bursae are fluid-filled sacs that are found within joints throughout the body. Their role is to act as ‘shock absorbers’ or lubricating cushions between moving parts, reducing friction and allowing smooth motion in any direction. With so many moving parts of bone and soft tissue within a small segment of the body, space can become an issue.
Subacromial bursitis refers to the bursa located beneath the acromion process of the scapula (figure 1.1). When the humerus is raised to shoulder height, space between the acromion and rotator cuff muscle (supraspinatus) narrows, leading to impingement, inflammation and pain. Figure 1.2 provides an example of compression on the subacromial bursa. Essentially, repeat and consistent impingement on the bursa can lead to chronic inflammation as excessive fluid fills the bursa, further reducing space between the bones and soft tissue. This can be attributed to overuse of the shoulder musculature and direct trauma or impact. It is important to note that impingement leads to inflammation of the bursa and may be present without a bursitis diagnosis.
So, let’s assume you’ve been experiencing painful symptoms of inflammation and diagnosed with subacromial bursitis, what’s next? Your GP will most likely recommend non-invasive interventions to begin with. Treatment can start with rest (possibly time away from work) and light range of motion exercises to reduce joint stiffness. The application of ice can be combined with anti-inflammatory medication such as Aspirin or ibuprofen to reduce swelling around the joint. Sometimes the bursitis can persist, in this case you may opt for corticosteroid injections to relieve symptoms by reducing inflammation. Unfortunately, this does not always work so surgery, a far more invasive method, is considered.
For best outcomes, exercise therapy should be performed concurrently with all the above treatments. If your bursitis is persistent, seeing an Accredited Exercise Physiologist is in your best interest. Controlled exercises can reduce pain and swelling by training the musculature and improving joint mobility. Muscle imbalance is a common cause of shoulder pain, by targeting the correct muscles with stretches and strengthening exercises one can correct muscular recruitment patterns, not to mention posture! Furthermore, increasing muscle strength and endurance around the joint will allow you a quick return to work and activities of daily living.
The Exercise Physiologist at Absolute Balance are experts in shoulder conditions and rehabilitation – contact us today!
B.Ex.SpSc, Grad.Dip.Ex.Sc (AEP, AES) (ESSAM)
Accredited Exercise Physiologist
Michener, L., Walsworth, M., Burnet, E. (2006). Effectiveness of rehabilitation for patients with Subacromial impingement syndrome: a systematic review. Journal of Hand Therapy. 17(2), 162-164. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0894113004000389