The bursa is an element of shoulder care and treatment that gets considerable airplay. It is also prone to a lot of confusion. Clearing up the confusion is my intention with this blog.
What is a bursa and what’s bursitis?
A bursa is a tiny sac filled with fluid. Functioning as a gliding surface in the spaces in your shoulder, the purpose of the bursa is to reduce friction between different tissue surfaces.
There are several bursa located in your shoulder. Bursitis occurs when the bursa becomes inflamed. The most common form of shoulder pain is found when the shoulder impinges on the bursa between the rotator cuff tendons and bone (acromion).
Symptoms of bursitis include:
- A progressive onset of shoulder symptoms over weeks or months
- External shoulder pain
- Pain spreading down the arm towards the elbow or wrist
- Pain that worsens when you lie on the affected shoulder
- Pain that worsens when you lift your arm above your shoulder
- Pain felt when you move your arm in an arc up or down
- Feeling limited pain when your arm is parallel to your body
- Pain felt when performing routine activities, such as washing hair, dressing, reaching upwards.
All of this is pretty straightforward, right?
Well, it is and it isn’t. What I’ve provided above is a list of symptoms, i.e. we haven’t yet touched on the cause of the bursitis.
I’ve found this approach to be very common. Many people I see for this shoulder condition focus on the bursa as the issue because of the symptoms they’re experiencing. They have a perception the bursa is the sole source of their troubles. A misconception, this view overlooks the many potential causes for the bursitis. It also denies the importance of the bursa’s role as a form of protection. The bursa is the body’s own defence and works like a pain ‘alarm’, alerting you to the inflammation and preventing you from causing even more pain and damaging your shoulder.
What are common causes of shoulder bursitis?
So let’s clear up this confusion.
A fact about shoulder bursitis, which is frequently misunderstood is there are underlying issues that led to the bursitis in the first place. With the shoulder being the most mobile joint in the body, it’s any wonder that bursitis presents here most commonly.
Chief among these issues is poor posture and structural causes, such as a rotator cuff tear or other injury that arises due to the adjacent structures. Frequently overlooked, people tend to think the cause should be something more complex. While the prognosis for some people is more complex, for those whose issue is poor posture or an injury such as a rotator cuff tear, it is possible for their bursitis to be addressed and optimised with specific exercises.
However, beyond poor posture, there are other structural challenges which cause bursitis. Accurate diagnosis is vital and can be achieved by a physical examination, x-ray, MRI (magnetic resonance imaging) scan and surgery.
Working with a dedicated shoulder specialist who can find the cause of your bursitis is important. Without the correct diagnosis, inappropriate treatment can be prescribed.
What is the best treatment for shoulder bursitis?
Treatment for shoulder bursitis will vary according to a person’s specific condition. There is a full spectrum of treatments, including RICE (rest, ice, compression, elevation), exercise, pain relief and surgery. Your shoulder specialist will help you to determine the ideal treatment for your specific condition.
At this point, it’s worth making some qualifying comments about pain relief for shoulder bursitis.
Pain relief, particularly pain relief delivered in the form of cortisone injections, has gained popularity as a treatment for shoulder bursitis. While there are people for whom cortisone injections is highly effective, there is a larger majority of people who aren’t as lucky.
With the rise in popularity for this treatment pathway, my professional opinion is there are too many cortisone injections dispensed as pain relief for shoulder bursitis.
I am careful with the prescription of cortisone injections and the most I will prescribe in a year is two or three. If a patient doesn’t gain significant relief on the first or second injection over a couple of months, I do not prescribe this treatment again.
Unfortunately, I have treated many patients who, prior to seeing me, have received up to 15 cortisone injections in a year – to no benefit. I feel many people continue to pursue this course of action because they feel helpless, want a quick fix, and haven’t worked with someone who’s prepared to investigate more deeply and understand the root cause of their bursitis.
The other unfortunate aspect of cortisone treatment is that the long term effects are not well understood. What we do know is that cortisone thins tissues. This mean if you have a torn rotator cuff and continue to inject it with cortisone, it could affect the potential for successful repair in future.
Cortisone is also known to increase the risk of infection, as it depresses the immune system and changes blood glucose (sugar) levels, a serious consideration for those with diabetes.
What’s the best way to manage bursitis?
My answer to this question is simple.
The best way to manage bursitis is to speak with a qualified shoulder specialist who will use a range of diagnostic tools to identify, address the cause of your bursitis, and identify a meaningful recovery journey for you.
When you have a clear understanding of where you are, it becomes easier to navigate your recovery roadmap.
Interested and want to know more? Get in touch.
Dr Sommit Dan is a leading Adelaide shoulder specialist. He provides minimally invasive and more complex treatment for all shoulder injuries and conditions. An Australian trained orthopaedic surgeon and highly skilled in arthroscopic (keyhole) shoulder reconstructions, rotator cuff repair and shoulder replacement surgery, Dr Dan treats patients as people. His goal is to his patients navigate the frequently challenging roadmap to recovery, empowering them along the way.