Shoulder Impingement & Bursitis
What Is Shoulder Impingement & Bursitis?
A bursa is a small, fluid-filled sac that reduces friction between bones, tendons, and muscles as they move against each other. The shoulder’s largest bursa, the subacromial bursa, sits between the rotator cuff tendons and the bony arch above them (the acromion). Shoulder bursitis occurs when this bursa becomes inflamed and irritated, filling with excess fluid and contributing to pain, especially with overhead movement.
What Causes Shoulder Impingement & Bursitis?
- Repetitive overhead activity, such as painting, throwing sports, or swimming
- Impingement, where the space between the rotator cuff and the acromion narrows, pinching the bursa during shoulder movement
- Direct trauma, such as a fall onto the shoulder
- Underlying rotator cuff irritation or tearing, which frequently occurs alongside bursitis, since the two structures sit right next to each other
- Less commonly, an underlying inflammatory condition or infection
What Are the Symptoms of Shoulder Impingement & Bursitis?
- Pain at the outer or top part of the shoulder, often worse with overhead reaching
- Pain that may radiate partway down the outer arm
- Discomfort lying on the affected shoulder at night
- Weakness with overhead activity, largely due to pain rather than true muscle weakness
- A pinching sensation, particularly when lifting the arm out to the side through a specific range of motion (often between roughly 60 and 120 degrees, sometimes called a “painful arc”)
Is Shoulder Bursitis the Same as Impingement?
The terms are closely related and often used together, since impingement — the mechanical pinching of the rotator cuff and bursa beneath the acromion — is one of the most common causes of shoulder bursitis. In practice, many patients are diagnosed with “subacromial impingement with bursitis,” reflecting that the irritated bursa and the mechanical pinching that caused it are really two sides of the same underlying problem. Addressing the impingement (through strengthening and mechanics-focused therapy) often resolves the bursitis as well.
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Treatment Options for Shoulder Impingement & Bursitis
Most cases of shoulder bursitis respond well to nonsurgical treatment:
- Rest and temporary avoidance of aggravating overhead activities
- Physical therapy focused on shoulder blade positioning and rotator cuff strengthening to reduce impingement
- Anti-inflammatory medication
- Corticosteroid injections into the bursa for more persistent cases
Surgery is uncommon for bursitis alone and is generally reserved for cases with an underlying structural cause — such as a bony spur significantly narrowing the space beneath the acromion — that hasn’t responded to a thorough course of nonsurgical treatment.
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Dr. Palsis specializes in the treatment of knee, shoulder, and sports injuries.