Subacromial bursitis is a painful, restrictive shoulder condition that affects the majority of patients at Pivotal Motion Physiotherapy.
Physiotherapy treatment of subacromial bursitis is about maintaining range of moment, strength and improving mobility of the neck and upper back. To assist patients with shoulder pain, call Pivotal Motion soon.
ABOUT THE SUBACROMIAL BURSITIS
Bursae are fluid filled sacs present in joints. A bursa serves to decrease friction in joints. The sacs are lined by a membrane called the synovial membrane and encompass the synovial fluid.
The subacromial bursa lies just below the bony prominence (the acromion) on the outside of your shoulder in between the supraspinatus tendon and a ligament, the corracoacromial ligament. Bursitis is a condition whereby this structure becomes irritated and inflamed.
Subacromial bursitis is a condition mistaken for a rotator cuff tears. Rotator cuff injuries can often occur in conjunction with bursitis.
CAUSES OF SUBACROMIAL BURSITIS
Patients with bursitis present with is one of Rotator cuff injuries or a sudden change in activity (like the time you decided to get back to playing tennis after a 5 year period where your only upper body exercise was hanging out the laundry).
There are a few factors apart from those mentioned above that can predispose a person to subacromial bursitis.
Some of these factors include the natural anatomy of your acromion (some people have an acromion that is more curved or hooked leaving less room for the bursae to move through), the presence of osteophtyes (more commonly known as ‘bone spurs’) as well as degenerative changes to the joint between your acromion and your collar bone (the acromioclavicular joint).
SYMPTOMS SUBACROMIAL BURSITIS
The symptoms of subacromial bursitis include pain with overhead movements and when lying on the affected side. In more severe cases where the bursa is grossly inflamed, there may be a dull constant ache at rest.
THE PAINFUL ARC OF MOVEMENT
Often there is a “painful arc of movement”; occurs when pain is felt in a particular range of movement as you elevate your arm. In the majority of cases, this range lies between 70 and 160 degrees of elevation. Beyond this point, the pain eases.
This presentation occurs as a consequence as the bursa is pinched within the subacromial space as the arm is lifted. As the elevation continues, the bursa moves further inward, clearing the acromion allowing pain free movement.
During some shoulder activities, such as arm elevation, rotating the shoulder, lifting, pushing or pulling or lying on the shoulder, friction and compressive forces are placed on the subacromial bursa. Pressure can be placed on the subacromial bursa following a direct impact or fall onto the point of the shoulder, elbow or outstretched hand.
When these forces are excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur. When this occurs, the condition is known as subacromial bursitis.
SUBACROMIAL BURSITIS PHYSIOTHERAPY
Conservative treatment in the form of physiotherapy is common treatment for shoulder pain.
Physiotherapy for subacromial bursitis involves reducing pain and inflammation to regaining full range of motion. There is little or no evidence for any benefit from the use of therapeutic ultrasound. Non-steroidal anti-inflammatories and ice are used to treat subacromial bursitis.
In some cases, a corticosteroid injection and in more recent cases Botox (Botulinum Toxin B) is prescribed as part of this treatment to provide short term relief from pain and inflammation.
In addition to relieving acute symptoms, your shoulder physio will teach correct postural and ergonomic factors, regain control of the shoulder blades as well as strengthen the muscles that stabilise the shoulder joint (rotator cuff muscles). Example of shoulder exercise can be found on this link.
Shoulder physiotherapy treatment progresses to regaining sport or work-specific skills as pain free movement is achieved. Shoulder rehabilitation involves proprioceptive training and agility training. Shoulder taping can also be pain relieving for shoulder pain.
SURGERY FOR SUBACROMIAL BURSITIS
Where conservative treatment is unsuccessful, surgery in the form of subacromial decompression may be necessary. This may involve removing the inflamed bursa as well as shaving off a portion of the acromion to allow the rotator cuff tendons to move through freely.
Subacromial bursitis is a manageable condition. At Pivotal Motion Physiotherapy, we take you through all the stages of rehabilitation with a treatment program individual to your needs.