Bursitis is the inflammation of the bursa, a fluid-filled sac that reduces friction between bones and soft tissues in the shoulder.
A bursa is a small, fluid-filled sac that reduces friction between moving tissues, and the shoulder has one situated between the rotator cuff tendons and the bony arch above them (the acromion). This subacromial bursa can become inflamed and swollen, a condition known as bursitis, which causes pain in a similar pattern to, and often alongside, rotator cuff problems.
Bursitis is generally a self-limiting, treatable condition, though it can be persistent if the underlying cause, such as repetitive overhead activity, is not addressed alongside the immediate symptoms.
Bursitis is most often caused by repetitive overhead activity, such as painting, swimming or throwing sports, which irritates the bursa through repeated friction and minor compression. A direct blow or fall onto the shoulder can also inflame the bursa, as can underlying conditions such as rheumatoid arthritis.
It frequently occurs alongside shoulder impingement and rotator cuff tendinopathy, as the same crowded space beneath the acromion affects both the bursa and the rotator cuff tendons. Less commonly, a bursa can become infected, which needs urgent medical attention rather than the usual course of treatment.
Common symptoms of shoulder bursitis include:
If pain is accompanied by fever, marked redness or warmth over the joint, this can occasionally indicate an infected bursa, which needs prompt medical assessment rather than routine treatment.
Initial treatment focuses on settling the inflamed bursa: rest from the aggravating activity, ice, and anti-inflammatory medication. Physiotherapy addresses the shoulder mechanics that contributed to the irritation, including rotator cuff and scapular strengthening.
A corticosteroid injection into the subacromial space is often very effective when symptoms are more persistent, settling inflammation directly at the source.
Surgery is uncommon and reserved for the minority of cases that remain significantly symptomatic despite a proper course of non-surgical treatment, where an arthroscopic procedure can remove the inflamed bursal tissue, often alongside addressing any co-existing impingement.
Most people with shoulder bursitis improve well with conservative treatment, often within a few weeks. Chronic or recurrent cases can occur, particularly if the underlying overhead activity or rotator cuff mechanics are not addressed, and may need more sustained management.
Shoulder bursitis is a common and usually straightforward cause of shoulder pain, closely related to rotator cuff impingement. Most cases settle well with activity modification, physiotherapy and, where needed, an injection, and surgery is uncommon. Persistent shoulder pain with overhead activity, or any redness, warmth or fever alongside the pain, is worth having assessed.
