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Shoulder Bursitis

Diagnosis & Treatment

Dr. Pamela Mehta, MD
Orthopedic Surgeon, San Jose

Table of Contents

What is Shoulder Bursitis?

Bursitis is a condition that can occur in the shoulders, hips, elbows, and knees. The shoulder is one of the most common joints to be affected by bursitis. Shoulder bursitis can cause long-term difficulties with pain and shoulder movement. Occasionally you will require surgery for shoulder bursitis.

Shoulder bursitis refers to inflammation of the bursae of the shoulder joint. Bursae are sacs filled with synovial fluid. These usually help to reduce friction and movement between bones and tendons. 

When there is too much friction, the shoulder bursae become irritated and inflamed. This leads to bursitis.

There are five main bursae around the shoulder. They include:

  • Subacromial-subdeltoid (SASD) bursa
  • Subscapular recess
  • Sub-coracoid bursa
  • Coracoclavicular bursa
  • Supra-acromial bursa
woman with shoulder pain

Causes of Bursitis

There are several causes of shoulder bursitis, including septic joint infection and trauma. Sports which involve punching, throwing, or swimming can also cause bursitis.

There is also an increased risk of bursitis in people who have health conditions such as:

Some are also at higher risk because they use their shoulders more than others. 

Examples of those who are more prone to bursitis include:

Symptoms of Shoulder Bursitis

Shoulder bursitis can cause several symptoms, including:

  • Shoulder pain
  • Stiffness
  • Swelling
  • Tenderness
  • Warmth
  • Limited mobility using your shoulder
  • Fever

These symptoms can come on in any order. Shoulder bursitis usually presents with pain, swelling, tenderness, and difficulty moving your shoulder. This is especially likely to be bursitis if you have had a fall or suffer from shoulder impingement.

Those with shoulder bursitis can also have trouble sleeping. Rolling onto your shoulder might put pressure on the inflamed bursa, worsening pain.

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Dr. Mehta is a board-certified orthopedic surgeon who can help you recover from your joint condition.

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Shoulder Bursitis Diagnosis

A thorough history and examination are so important in this condition. This is because we can often diagnose shoulder bursitis using only these two factors. Your orthopedist may still recommend investigations, but it’s not always necessary.

When asking about your symptoms, we may ask various questions including:

shoulder examination
  • Where it hurts
  • When the pain started
  • What the pain feels like
  • Whether the pain moves elsewhere
  • What makes the pain better or worse
  • When you feel the pain most
  • Severity of the pain
  • If you have a fever

We may also ask about any activities you take part in which use repetitive overhead activities.

When examining your shoulder, your orthopedic doctor will assess the pain and range of movement. Shoulder bursitis often causes a reduced range of active movement. This means it might be harder to raise or twist your arms, alongside other movements.

You may have the most pain when raising your arms from 70 to 120 degrees (called “the painful arc”). This is due to compression of the sub-acromial bursa during this movement.

You may also have tenderness over parts of the shoulder joint. The tender area may help your doctor determine which bursa is inflamed. You may also be able to see some redness or feel some warmth, over the area that’s inflamed.

shoulder pain on trapezius

Differential Diagnosis

Bursitis is often caused by other medical conditions. For example, the following conditions can all cause shoulder bursitis:

Your doctor will also need to rule out other conditions which cause shoulder pain and difficulty moving.

Investigations for Bursitis


X-rays can’t usually establish the diagnosis of bursitis by themselves. They can sometimes detect calcification in the bursae when bursitis has been chronic.

X-rays also help to rule out other causes of shoulder pain that involve the bones and ligaments.

shoulder ultrasound


Ultrasound is a non-invasive test that uses sound waves to create images of the inside of your body. In shoulder bursitis this will show inflammation and fluid build-up in the bursa. We also use ultrasound to guide steroid injections, a potential treatment.When looking at a bursa on an ultrasound machine, your doctor will be able to see features of bursitis. These include bursa wall thickening, increased fluid, or changes to the surrounding tissue.

MRI (Magnetic Resonance Imaging)

An MRI is a machine that uses a strong magnetic field to create detailed images of the inside of your body. If we’re not able to diagnose shoulder bursitis from the history and examination, we can use MRI. An MRI scan will confirm bursitis if it shows inflammation and fluid buildup in the bursa.On MRI, the bursa is seen as a fluid-filled structure. CT scans shows the inflamed bursa as the hypodense area with an enhancing wall. Clinically, bursitis mimics several peripheral joint and muscle abnormalities.

Shoulder Bursitis Treatment

Treatments for shoulder bursitis focus on reducing inflammation and minimizing symptoms. The treatment depends on the type of bursitis you have.

Exercises for shoulder bursitis are very useful in this treatment. These should be done under supervision of a shoulder surgeon or physical therapist.

Treatment Options for All Types of Bursitis

If shoulder bursitis is chronic or isn’t responding to treatment, you may need surgery. Here are the medical treatments for the different forms of bursitis:

shoulder bursitis treatment

Chronic Bursitis

We treat chronic bursitis by aiming to reduce activities that cause swelling. Additionally, for a few weeks, your doctor may recommend:

  • Anti-inflammatory medication
  • Applying ice 2-3x per day for 30 minutes
  • Avoiding heat treatment

If these fail to treat your symptoms, your doctor might suggest a steroid injection. This decreases swelling and inflammation but may have unwanted side effects. For this reason, your doctor may suggest physical therapy and other treatments first.

However, if your symptoms remain after a few weeks of medication, ice, and physical therapy, a steroid injection can be trialled.

shoulder bursitis injection

Infected Bursitis

Infected bursitis requires immediate evaluation by the doctor. Aspirating the bursa (taking fluid out with a needle and syringe) may be an option. This will reduce its size and will collect fluid needed to diagnose an infection. This fluid will be tested to determine what is causing the infection.

If it’s confirmed that your bursa has a bacterial infection, you will need antibiotics. The true danger with this type of bursitis is the risk that bacteria can spread to the blood. The choice of antibiotic will depend on what bug is causing the infection (often staph aureus).

Like other forms of bursitis, ice, rest, and medication can also reduce swelling and pain.

Traumatic Bursitis

If your bursitis has been caused by trauma (such as in a fall, injury, or during sports), your doctor may suggest aspiration. This means that they will draw the fluid or blood from the inflamed bursa with a needle and syringe.

You can also use the other tactics, such as rest, ice, and anti-inflammatories.

Preventing Recurrence

Once your symptoms have improved and your doctor has said you can return to activities, you still need to be cautious. Here are a few tips to help you prevent recurrance of shoulder bursitis:

  • Use shoulder dressings, bandaging, or sports padding during sports activities
  • Warm up and cool down with gentle shoulder stretches before exercise
  • Continue to work on your shoulder health with strengthening exercises
  • Stop and rest as soon as you feel any shoulder pain or irritation
  • See a shoulder doctor if any of these symptoms are persistant


Shoulder surgery is rarely needed to treat bursitis. This is usually done only in chronic cases that are not better after 6-12 months of medical treatment.

If you do need surgery, your doctor will most likely do it arthroscopically. This is a minimally invasive surgery which reduces scarring and improves recovery time. In arthroscopy, they will make small incisions in your skin and insert surgical instruments to remove damaged tissue.

What If My Shoulder Bursitis Won’t Go Away?

Symptoms of shoulder bursitis should improve with proper treatment. Consult a doctor if the symptoms don’t improve with home care. Home care for bursitis involves the following:
woman with red shoulder being squeezed

If you have already undergone treatment for shoulder bursitis, such as surgery, make sure to see a doctor if the signs of infection appear. The most common symptoms of infection are excessive warmth at the site of the inflamed bursa, pain, tenderness, and fever.

You should schedule an appointment to see a doctor if you notice the swelling is persistent and doesn’t respond to treatment. The doctor will assess the severity of your symptoms and readjust the treatment protocol.

Keep in mind there is no quick fix for shoulder bursitis. It can take several weeks to experience improvements in inflammatory symptoms. Both patience and consistency are important for successful recovery. That’s why it’s important to make sure your health is in good hands. 

What Shoulder Services Do We Offer?

Shoulder Pain Assessment

Shoulder Pain is frustrating and can impact both your sleep and your mental health. Dr. Mehta is a shoulder doctor and can diagnose your pain, offering various surgical and non-surgical treatments.

Shoulder Surgery

If your shoulder condition is severe, or nothing you have tried has helped, Dr. Mehta can advise you on the options for surgery. She is a shoulder specialist and can offer expert opinion and care.

Treatment of Shoulder Conditions


Frozen Shoulder

Frozen shoulder makes your shoulder stiff and can make movement painful.

Bicep Tendinitis

Bicep tendonitis causes pain in your upper arm and can lead to a bicep tendon tear.

Shoulder Impingement

Shoulder impingement makes it difficult to raise your arms above your head.

Shoulder Bursitis

Shoulder bursitis gives you a tender shoulder and makes it difficult to sleep.

Rotator Cuff Tear

Rotator cuff tears can occur during sports and make overhead movements difficult.

Dislocated Shoulder

Shoulder dislocation causes a disformed and painful shoulder and can be recurrent.

Shoulder Separation

Shoulder separation is a sprain in the AC joint near your shoulder.

And Many More!

Dr. Mehta offers diagnosis and treatment of all shoulder conditions and can offer her specialist opinion as an expert shoulder doctor.

Expert Advice For Shoulder Problems