Shoulder Bursitis
Diagnosis & Treatment
Dr. Pamela Mehta, MD
Orthopedic Surgeon, San Jose
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 refers to inflammation of the bursae of the shoulder joint, which 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, leading 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
Causes of Bursitis
- Trauma
- Excessive use is seen in sports-related activities pinching, throwing, or swimming.
- Septic infection
- Carpenters
- Musicians
- Athletes
- Gardeners
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, though the typical presentation of shoulder bursitis is of pain, swelling, tenderness, and difficulty moving your shoulder. This is especially indicative of bursitis if you have recently had a fall or suffer from shoulder impingement.
Those with shoulder bursitis can also have trouble sleeping – rolling over the injured shoulder might put pressure on the inflamed bursa, escalating the pain when sleeping.
Book a Consultation with Dr. Pamela Mehta, MD
The Best Orthopedic Surgeon in San Jose
Dr. Mehta is a board-certified orthopedic surgeon who can help you recover from your joint condition.
We can help if you:
- Are Suffering From Pain and Mobility Issues
- Need Orthopedic Assessment and Advice
- Want Treatment From a Top Orthopedic Doctor
Call On 408-559-3888
or Send a Message.
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:
- 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.
Differential Diagnosis
Bursitis is often caused by other medical conditions. For example, the following conditions can all cause shoulder bursitis:
- Frozen shoulder
- Shoulder impingement
- Rotator cuff tendinopathy and tear
- Other tendon problems
Your doctor will also need to rule out other conditions which cause shoulder pain and difficulty moving.
Investigations for Bursitis
X-ray
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.
Ultrasound
Ultrasound is a non-invasive test that uses sound waves to create images of the inside of your body. We sometimes use this to diagnose shoulder bursitis by showing inflammation and fluid buildup in the bursa. We also use ultrasound for steroid injections into the bursa, which is a potential treatment.
When looking at a bursa on an ultrasound machine, your doctor will be able to identify typical features of shoulder bursitis. These include bursa wall thickening, increased fluid, or changes to the surrounding tissue.
MRI (Magnetic Resonance Imaging)
Magnetic resonance imaging (MRI) is a machine that uses a strong magnetic field to create detailed images of the inside of the body. If we’re not able to diagnose shoulder bursitis from the history, examination, or ultrasound, 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.
If shoulder bursitis is chronic and does not respond to treatment, surgery may be recommended. Here are the medical treatments for the different forms of bursitis:
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 simple treatments before injection.
However, if your symptoms remain after a few weeks of medication, ice, and physical therapy, a steroid injection can be trialled.
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.
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
If your symptoms have improved and your doctor has said you can return to activities which caused the problem, you need to be cautious.
Dressings, bandaging, or sports padding are recommended to protect your shoulder joint and prevent recurrence.
Shoulder Bursitis Surgery
The most common surgical treatment, if needed, is an incision and drainage (called an I and D) and is used only in cases of infected bursa. The surgeon first numbs the skin with an anesthetic and then opens the bursa with a scalpel. Finally, they drain the fluid be it blood or pus present in the inflamed bursa.
Other surgical procedures include:
Bursectomy
The inflamed bursa is removed through a procedure called a bursectomy. This is done with a single open incision or arthroscopically (which requires 2 or 3 small incisions).
After a bursa is removed, a new bursa may form in its place. The idea behind it is that the new bursa is less prone to irritation and causing painful symptoms. Bursectomy has several benefits, as removing the inflamed bursa may reduce pain and inflammation. This can reduce the need for long-term anti-inflammatory drugs, physical therapy, and time away from work or school. The bursectomy also reduces the need for more surgery by removing only the affected area.
Sub-acromial Decompression (Acromioplasty)
During sub-acromial decompression, the surgeon removes or shaves down part of the shoulder joint. This gives the rotator cuff, tendons and subacromial bursa more room. By creating more space there is less chance of infection and inflammation. The long-term function of the shoulder joint is usually unaffected.
This surgery is recommended based on symptoms and how your bursitis looks on an MRI scan.
Tendon and Muscle Repair
Your orthopedist may advise surgery to repair the damage if rotator cuff muscle or tendon injury is the root cause. For example, a torn tendon may be repaired and reattached to the humeral head.
Surgical Risks and Complications
Surgery is never risk-free and must only be performed when the benefit outweighs the risks. Complications may include:
- Complications from anesthesia
- Infection (rare with arthroscopic procedures)
- Nerve injury (extremely rare)
- Blood vessel injury (extremely rare)
- Bleeding (extremely rare)
- Shoulder stiffness
- Failure of repair,
- Failure to improve your symptoms as much as you had hoped
- Complex regional pain syndrome
Additionally, after any surgery, DVT and Pulmonary Embolism (PE) are risks. This is when a blood clot forms in your arms and legs (DVT) and travels to your lungs (PE).
After surgery, your shoulder will be placed in a sling as directed by your doctor. The sling is used to limit the motion of your shoulder so that the rotator cuff tendon can incorporate and heal.
In some cases where the repair must be carefully protected, your arm may be placed in a sling with a pillow that is attached around your waist. It is very important to wear your sling as directed by your doctor after surgery. Return to full activity ranges from six to eight weeks.
Advice After Surgery
Pain Management
When you are discharged from the hospital, you will be given a prescription for pain medicine.
You need to take painkillers daily at the prescribed time.
Shoulder Sling
The sling is typically used for 2 to 6 weeks after surgery.
You should not do any reaching, lifting, pushing, or pulling with your shoulder during the first six weeks after surgery, unless specifically advised to by your doctor.
You should not reach behind your back with the operative arm. You may remove your arm from the sling to perform the recommended exercises, bend and straighten your elbow, and move your fingers several times a day.
You may remove the sling to bathe, dress, and perform elbow range of motion several times a day.
Diet
We recommend that you eat a light diet the evening of surgery and the next day.
You may resume eating a regular diet as soon as you tolerate it.
Ice Therapy
You may use ice bags or a bag of frozen vegetables to ice your shoulder.
You can also consider buying a cold pack machine. This machine has a sleeve that is attached to an ice cooler. This circulates cold water through the shoulder sleeve providing relief of pain and swelling after surgery.
- Ice your shoulder two to five times per day for at least 10 minutes until the swelling has calmed down, especially before sleep.
- We do recommend that you put a t-shirt or a thin towel between you and the sleeve so that it doesn’t put pressure or injure your skin.
Sleeping
We recommend that you try sleeping in a reclined position in bed. You may place a pillow between your body and your arm, and behind your elbow, to move your arm away from your body slightly. You should wear your sling when you sleep.
If you needed rotator cuff surgery, it is frequently exceedingly difficult to fall asleep. Your sleep-wake cycle could be disrupted by the surgery itself. Additionally, when lying flat on their backs, many patients have increased shoulder pain.
Don’t try to sleep on the shoulder we operated on for at least 6 weeks.
For more information, including how to sleep with a shoulder sling, check out our article on how to sleep with shoulder pain.
Driving
You may find it challenging to drive a car because you can’t use your operating arm. Also, if you are taking strong painkillers your ability to concentrate on driving may be affected.
Whether you decide to drive depends on how easily you can operate a vehicle with one hand, and what the local laws are in your area. Driving a car while under the influence of narcotic medicine is not advised.
Physical Therapy
Physical therapy prescriptions and the timing of these interventions are determined case-by-case.
On your initial postoperative appointment, this will be discussed with you. Your surgeon or the nurse in the recovery area may give you instructions to start doing mild range-of-motion exercises the day before surgery.
Caring for Your Surgical Incision
You may remove your dressing and shower 48 hours after surgery if you do not have a pain catheter. If you had a biceps tenodesis surgery, you should leave your dressing on for few days after surgery.
If you have a pain catheter, this should be removed by a family member 72 hours after surgery along with the shoulder dressing before showering.
You should not get in a bath and immerse the incisions underwater for six weeks, but you may get in the shower and let the water run over them. Pat the incisions dry afterward and cover them with dressings. There is no need to place any ointments over the incisions.
If you notice any discharge, swelling, or increased pain five days after surgery please call your doctor.
Redness around the incision is very common and should not be a concern. However please consult your doctor if you have:
- Redness or a discharging wound present five days after surgery
- Redness spreading away from the surgical incision site.
- Redness and fever greater than 100F
Testimonials
How Resilience Orthopedics Can Help
Dr. Pamela Mehta, MD – Orthopedic Surgeon in San Jose, California
Dr. Pamela Mehta is an orthopedic surgeon and a specialist in shoulder conditions including bursitis. Dr. Mehta is an expert shoulder surgeon and uses cutting-edge minimally invasive surgical techniques to improve your bursitis if required. Dr. Mehta won’t try to talk you into something you don’t need – you can work with her to improve your shoulder pain together.
Resilience Orthopedics is based San Jose, California. To make sure you get the right diagnosis and treatment the first time, get in touch to begin your journey to recovery.
Further Information
Learn about the causes of shoulder pain, what the diagnosis could be, and the treatments available.
Learn about shoulder surgery, including minimally invasive surgical techniques like shoulder arthroscopy.
Shoulder Conditions
Learn about different shoulder conditions, their symptoms, how they are diagnosed, and what treatment we can offer at Resilience Orthopedics, including:
