Subacromial bursitis has similar symptoms to Supraspinatus tendinitis. In particular shoulder pain over a 60-degree arc when the arm is lifted out sideways.
Symptoms of subacromial bursitis can be similar to those of supraspinatus inflammation and consist of:
- Pain and weakness in the arm, particularly when it is lifted sideways through a 60-degree arc.
- Pressing in over the inside, front of the shoulder will be painful and tender.
- If it is the tendon that is injured rather than the subacromial bursa, then there is likely to be noticably more pain when the arm is lifted up sideways against resistance.
What is a subacromial bursitis?
Subacromial bursitis is inflammation of the the subacromial bursa which sits between the supraspinatus tendon and the bone in the shoulder. A bursa is a small sack of fluid. Its function is to help lubricate movement of the shoulder joint.
The Supraspinatus muscle runs along the top of the shoulder blade (scapula) and inserts via the tendon at the top of the arm or humerus (upper arm) bone. The muscle lifts the arm up sideways and is important in throwing sports. As one of the rotator cuff muscles it holds the arm in the shoulder when you release what you are throwing.
What causes subacromial bursitis?
Overuse is usually the underlying cause, especially in sports where the arm is held overhead a lot. This bursa can become trapped causing pain and inflammation. Injury to the supraspinatus tendon may result in inflammation. As a result, the space in the joint is reduced, therefore increasing the likelihood the subacromial bursa will become impinged.
Large forces are involved when throwing, in particular when slowing the arm down after releasing the throwing implement. Few athletes people bother to train the rotator cuff muscles, preferring to concentrate more on the muscles which accelerate the arm rather than decelerate it.
A heavy fall onto the shoulder can also result in injuring the supraspinatus muscle, which may also lead to bursitis.
What can the athlete do?
- Rest – until there is no pain. Rest is important as every time movement causes pain in the shoulder the time taken to recover will be longer as the bursa becomes inflamed and swollen.
- Mobility – if possible however continue pain-free mobility exercises to keep the full range of movement in the shoulder. This is important to prevent loss of movement in the shoulder and eventually muscle weakness.
- Ice – apply cold therapy to reduce pain and inflammation. A cold pack or wrap can be applied every hour for 10 minutes reducing to 4 times a day as required.
- Advice – see a sports injury specialist or doctor who can advise on subacromial bursitis treatment and rehabilitation.
What can a sports injury specialist or doctor do?
- Medication – a doctor may prescribe anti-inflammatory medication such as ibuprofen. This will help reduce pain and inflammation quite quickly although always consult a doctor before taking medication. Ibuprofen should not be taken if you have asthma.
- Rehabilitation – they may prescribe a full rehabilitation program to include mobility and strengthening exercises.
- Aspirate – if Subacromial bursitis does not respond to normal conservative treatment of rest and cold therapy then a doctor may aspirate the bursa which involves extracting the extra fluid through a needle injected into the bursa.
- Surgery – a surgeon may operate on persistent subacromial bursitis injuries.
References & further reading
- Wilk KE, Obma P, Simpson CD et al. Shoulder injuries in the overhead athlete. J Orthop Sports Phys Ther 2009;39(2):38–54
- Balke M, Schmidt C, Dedy N et al. Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop 2013;84(2):178–83