If you're experiencing shoulder pain, it's possible that you may be suffering from sub-acromial bursitis. This condition is caused by the inflammation of a bursa – a small, fluid-filled sac that helps to cushion and lubricate joints. In the case of sub-acromial bursitis, the bursa sits just below the acromion (the raised bone on the top of your shoulder). The tendon that runs from your shoulder blade to your upper arm can rub against this bursa, causing pain and inflammation. Thankfully, there are many ways to treat shoulder bursitis effectively. In this article, we'll take a look at what causes this condition, as well as some of the best ways to treat it.
What is a bursa and why is it painful?
As we mentioned, a bursa is a small, fluid-filled sac that helps to cushion and lubricate joints. Think of a water balloon. This liittle balloon sits between tendons and bones and prevents the tendons from rubbing on the bone. If we didn't have bursas, our tendons would be constantly becoming inflamed and angry due to all the friction!
These bursa become painful when they become inflamed. The inflammation can happen for 2 main reasons;
1) The inflammation is coming from within the bursa - this happens in shoulders when someone falls directly onto their shoulder or the shoulder takes a heavy blow right to the point
2) The inflammation enters the bursa from the tendon - this is by far and a way the most common form of shoulder bursitis that we see at Fixio Physio Northern Beaches.
Why does it hurt so much to move my arm?
The shoulder is a very flexible joint. It has a large range of movement and can rotate in many different directions. This makes it great for activities such as swimming, tennis and throwing a ball but it also makes the shoulder more susceptible to injury.
One of the main reasons that shoulder bursitis is so painful is because the shoulder has such a large range of movement. When the bursa becomes inflamed, it can make even the simplest of movements incredibly painful.
There also isn't a whole lot of space in the top of the shoulder joint. Any form of inflammation, even small amounts, can result in very large amounts of pain. The good news is, just because there is lots of pain doesn't necessarily mean there is lots of damage!
So the bursa may not be the cause, the tendon is?
Yes! Medical imaging is very good at telling us that a bursa is inflamed and swollen. However it doesn't tell us why the bursa is swollen. This is the key, in that once you solve the cause you then get much faster and more permanent results.
The key for most shoulder bursitis is to identify which of the rotator cuff muscles is weak or not firing correctly and then giving it the appropriate physiotherapy treatment. You can read more in depth about it here.
Yes there is a fix, but not in drugs and rest
The shoulder is a very complex and mobile joint. It is made up of 4 bones, the shoulder blade, collar bone, upper arm bone and the shoulder joint itself. There are also many muscles, tendons and ligaments that cross this shoulder joint making it an extremely strong and stable joint...when all these structures are working correctly!
The fix is to assess the shoulder in a holistic fashion. This starts with assessing how much mobility it has and then delves into the biomechanics of the shoulder during movements and finishes off with strength assessments. With such a finely tuned piece of equipment such as the shoulder, it requires an expert sports physiotherapist or musculoskeletal physiotherapist to be able to assess and write a comprehensive program.
I got told to have an injection...
Cortisone injections are shown to be extremely beneficial in subacromial bursitis... only if the physiotherapy rehabilitation AFTERWARDS was done well. Most people can achieve full range of motion, no pain and a return to their favourite activities without the need for an injection into their shoulder or the need for taking lots of medication.
Who do I talk to about it?
Give us a call at Fixio Physio. We've been treating shoulders like yours for over a decade with amazing results. Let's get you back to doing what you love, without medication, injections or surgery! If you're ready to get on top of it you can book online here.