The subacromial bursa is a containment of fluid that serve the purpose of buffering regions within the shoulder complex that are subject to a lot of rubbing or sliding of tissues such as tendons and fascia against each other or bony prominences. Typically, the sub acromial bursa buffers the supraspinatus tendon against irritating friction against the overlying acromion process, particularly with overhead activities. Unfortunately, the bursa itself often becomes irritated and inflamed when subjected to longstanding friction or mechanical irritation. The sub acromial bursa, once inflamed and irritated typically restricts a person’s ability to perform overhead activities such as throwing or swimming. In more severe cases, even simple movements such as reaching overhead, or reaching forward to grasp a door handle may be limited by pain.
Although it is often dispensed as a specific diagnosis, I think it is probably rare that a shoulder pain is driven solely, or even predominantly by an inflamed bursa. More common, I would argue, would be the scenario where there is elevated nerve ending sensitivity in and around the shoulder joint, which has arisen secondary to an acute trauma/injury or an accumulative irritation of joint structures from occupational or sporting activities. The reason I point this out is that treatment of “bursitis” should not focus solely on a specific effort to treat the bursa itself. The initial goal is to desensitize the shoulder so that there is less protective muscle guarding present, and more tolerance to movement.
We achieve this through activity modification, joint mobilisation, massage and occasionally a referral out for a cortisone injection. Once the shoulder is, let’s say “calmer”, the concentration of inflammatory mediators in and around the shoulder generally, and sub acromial space specifically, is likely to reduce and symptoms should track towards resolution. As movement becomes easier and less symptomatic, we can shift attention towards graded strengthening and conditioning.
If the primary problem is one of ramped up nerve ending sensitivity, we should see a very positive response to treatment and full recovery over a 4-6 weeks period. If there is a very slow response, or if symptoms do not improve, we need to consider what else might be sustaining the shoulder’s heightened state of nerve ending sensitivity and joint irritation. It might be that there is a degree of structural wear and tear that is sustaining the bursitis. Occasionally a cortisone injection is a useful intervention. In more intractible cases, as surgeon may choose to carry out a “subacromial decompression”. In this procedure, some of the bursa is removed surgically. A surgeon may also perform an “acromioplasty” whereby extra space is created for the supraspinatus tendon by removing a small section from the acromion process.
The need for surgery, in my experience is low. Most cases of sub acromial bursitis respond well to non-surgical interventions including activity modification, mobilisation and stretching of the shoulder, massage and a graded strengthening program. Call us on 9665 9667 to discusss your shoulder symptoms.
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