Shoulder bursitis is an inflammation of the bursa—a fluid-filled sac designed to cushion the joint. We have 160 bursas throughout our entire body. Any of these bursas can become inflamed, but the most common areas include the knee, hip, shoulder, and elbow. This condition can happen alone or in conjunction with other shoulder maladies. To prevent further irritation and reduce the risk of recurrence, it’s important to assess and treat the underlying cause of the condition.
Shoulder bursitis is a painful but common condition that affects thousands of people each year. Simply put, shoulder bursitis is when the bursa (fluid-filled sac) in the shoulder joint becomes inflamed. If you think you might have shoulder bursitis, see a medical professional as soon as possible. Treatment will vary. Doctors may recommend a cortisone shot to reduce the inflammation. This will reduce your immediate symptoms, but will not address the underlying cause. If your doctor recommends only the shot, be your own health advocate and request additional treatment options like physical therapy, occupational therapy, or at-home remedies.
The primary symptoms of shoulder bursitis are swelling and pain. The suffix “-itis” literally translates to mean inflammation—a combination of swelling, heat, and redness. Since the bursa is located deep within the shoulder joint, this inflammation may not be visible to the naked eye, which is why it is important to see a medical professional.
The pain from shoulder bursitis can be mild or severe. It is usually most prominent during movement. People experiencing shoulder bursitis may also notice a reduced range of motion.
In rare cases, the bursa in the shoulder becomes inflamed as a result of infection. This can be quite serious. Signs of infection include:
• Chills and sweating
• Sore throat
• Stiff neck
• Burning sensation
• Excessive swelling
• Sudden decrease in blood pressure
A bursa is a fluid-filled sac designed to cushion a joint during movement. The bursa in the shoulder is located between the ball and socket of the shoulder—between the top of the upper arm bone (humerus) and the shoulder socket (acromion fossa of the scapula). Most commonly, this bursa becomes inflamed due to repetitive-use injuries and poor posture. These two irritants cause inflammation in the surrounding body tissues of the shoulder and decrease the space in the shoulder joint. This puts undue pressure on the bursa and causes it to become inflamed. This condition rarely requires surgery, but sometimes it requires a doctor to remove some of the excess fluid with a needle and syringe.
Shoulder bursitis can be the result of:
• Shoulder trauma
An acute trauma of the shoulder (like from falling, bumping it, or injuring it in a car accident) can cause the bursa to fill with blood. This is a reflexive response of the nervous system and is okay if the inflammation only lasts a short period of time. However, if the inflammation persists, bursitis can develop.
• Repetitive-use injury
More commonly, bursitis is considered a repetitive-use injury. Instead of one big trauma, think of a repetitive-use injury like a series of “mini-traumas.” Painters, swimmers, tennis players, and baseball pitchers are at increased risk of developing shoulder bursitis.
• Shoulder impingement/rotator cuff tendinitis
Shoulder impingement and rotator cuff tendinitis can both lead to shoulder bursitis. The inflamed tendons can irritate the bursa, causing it to become inflamed. Similarly, bursitis can lead to the development of shoulder impingement or rotator cuff tendinitis. If you suffer from one of these conditions, beware that it can have a domino effect, leading to the development of all three. This is why early diagnosis and treatment is especially important for shoulder maladies.
Due to the natural deterioration of muscle, bone, and other types of connective tissue with age, the structure of the shoulder joint can become compromised. If the shoulder joint does not have adequate space, the bursa may rub against the bones, muscles, tendons, or ligaments and become irritated and inflamed.
• Poor posture
Habitually maintaining a poor posture—slumped spine, rounded shoulders, protruding chin—increases your risk for developing shoulder bursitis. Poor posture often means there is less than optimal space in the shoulder joint, resulting in friction between two or more parts of the shoulder joint. If one of these parts is the bursa, then bursitis can develop.
• Previous incidence
If you have had shoulder bursitis in the past, you are more likely to develop it in the future. It can become a recurring problem if the underlying issue (like posture or improper athletic form) is not addressed.
• Bone spurs
If you develop bone spurs or calcium deposits in the shoulder joint, they can rub against and irritate the shoulder bursa, leading to bursitis.
• Bacterial infection
In rare cases, the bursa can become inflamed due to a bacterial infection. A bacterial infection must be treated with antibiotics immediately. If left untreated, it can lead to septic shock and potentially even death.
- Sit tall. Measure the distance between your lowest rib and the top of your hip with your thumb and pointer finger. Now, challenge yourself to lengthen that distance by sitting tall—creating more space between your bottom rib and the top of your hip. Now, organize your shoulders by opening your collarbones—pulling them away from each other to broaden your chest—and pull the tips of your shoulder blades down your back. Notice how you suddenly look and feel taller. Sitting tall keeps your upper body in optimal alignment, reducing any chance for slumping. The seated slump overstretches your shoulder and neck muscles, weakening them and increasing the possibility for shoulder and neck injury.
- Get strong! Building muscular strength, particularly in muscles in and around the shoulder joint, greatly decreases the risk of developing shoulder bursitis. Muscle groups like the rotator cuff muscles, trapezius muscles, deltoids, and pectorals are particularly important for maintaining proper shoulder alignment. Focus on creating a balance of strength and stretch in these muscle groups.
- Notice your alignment while lifting the arm overhead. Think of an activity you do regularly that involves lifting your arm to or above shoulder height (like styling your hair, installing ceilings, or playing tennis). Now, notice your alignment, particularly in your shoulders. Does your shoulder raise up toward your ear or round forward as you lift the arm? If so, pause and focus on pulling the shoulder blades down the back toward the feet and pulling the collarbones wide to promote better alignment and range of motion while doing these activities.
1. Align the Shoulders. The best way to prevent shoulder bursitis is to find proper alignment in the shoulder joint. With proper alignment, there is adequate space for all the parts of the shoulder joint to coexist and do their jobs efficiently. When this space is lost, the risk of developing injuries in the shoulder increases dramatically. To Align the Shoulders, first pull the collarbones wide—create width between the outer tips of the shoulders without compromising the space between the shoulder blades; then push the shoulder blades down toward the feet, creating space between the shoulders and the ears. In everyday life, you can Align the Shoulders while carrying a heavy bag. Instead of letting the shoulders slump under the weight of the bag, pull your collarbones wide. With each exhale, let the pressure of the bag’s strap remind you to push the shoulder blades down the back toward the feet.
2. Stimulate the Spine. One of the best ways to support proper alignment in the shoulders is to find proper alignment in the spine. A slumped spine leads to the shoulders rounding forward, which puts you at greater risk of developing shoulder bursitis. To maximize the benefits of aligning the shoulders, focus on stimulating the spine. To Stimulate the Spine, set your gaze slightly above the horizon, and pull the chin back as if making double, triple, even quadruple chins! This aligns the head atop the spine. Now, lengthen the spine to reverse the compressing effect of gravity by increasing the space between the tail and the head. To do this, create opposition by pushing your feet down and pulling the crown of your head up. In everyday life, you can Stimulate the Spine while waiting for the bus or train. First, align the head atop the spine. Now, exhale to push the feet down. Keep the feet pushing down toward the earth, and now inhale and stretch the crown up toward the sky.
3. Mobilize the Ribs. Shoulder bursitis is primarily an inflammatory condition. Deepening the breath reduces our body’s stress response to injury, and consequently, will decrease our production of inflammation. To Mobilize the Ribs, expand the ribs in all directions on your inhale—toward the back, sides, and front. On your exhale, contract the ribs toward center. Start by noticing your natural breath and breathing tendencies. Then, actively expand and contract the ribs. You can use a mirror to see where you tend to inhale or exhale, or better yet, place your hands on your ribs and feel the movement. If you typically breathe in the front of your ribs, try to inflate the back of your ribs. It may be harder than you imagine. Since you are constantly breathing, you can Mobilize the Ribs any time of day. Practice while waiting on your morning coffee or tea, walking down the street, or warming up before you exercise. Notice the ribs expand wide as you inhale. Now, actively contract the ribs as you exhale. Challenge yourself to keep the side body—the space between the ribs and hips—long as you contract.
RICE. RICE stands for Rest, Ice, Compress, and Elevate. These are the four steps to reducing inflammation in an injured area. If your doctor has diagnosed you with shoulder bursitis, the first step is to rest. If you notice the pain specifically during certain activities, take a break. Apply ice for 10 to 15 minutes 4 to 6 times a day. Compression sleeves can add support and further reduce inflammation. Elevate the affected area above the heart as often as possible to take advantage of gravity, which will help draw blood back to the heart, reducing swelling even further.