What is subacromial bursitis?
Subacromial bursitis is the painful inflammation and swelling of the subacromial bursa that is situated between the acromion, a boney prominence above the shoulder joint and the humeral head which forms the shoulder joint itself. A bursa is a small fluid filled sac that forms around joints in areas where there is a lot of friction between muscles, tendons and outcrops of bone. The bursae position themselves in between the tendon or muscle and the bone buffering any friction from movement. To picture a bursa imagine a very small water filled balloon that sit in places where things rub against each other, for example between a tendon and a bone, to provide a soft smooth cushion for the tendon to pass over painlessly. The covering of the bursa also acts as a lubricant and aids the tendons movement. It is estimated that there are over 150 bursae in your body which protect the joint and tendons from wear. They are all very small and unnoticeable until they become swollen and painful with bursitis.
Why & when does subacromial bursitis happen?
Subacromial bursitis can be caused through injury, infection or be can be triggered by certain health conditions. If bursitis develops as a result of injury then it will normally be due to a repetitive strenuous activity involving repetitive overhead reaching or compression through the shoulder, such as lying on it or falling with your arm outstretched. This puts more pressure over the bursa as the joint compresses it and the surrounding tendons rub more tightly over it, irritating it and triggering a painful inflammatory reaction (swelling). This risk of developing bursitis in this way is greater for those whose jobs or hobbies involve a lot of repetitive movement. Examples of this are painters and decorators who spend a lot of time with their arms raised above their head therefore have a greater risk of developing subacromial bursitis. In the same way carpet fitters and gardeners spend a significant amount of time kneeling and therefore are more at risk of bursitis in the knee. Runners have a greater likelihood of developing bursitis in the hip. Bursitis can also be brought on by excessive pressure or direct impact trauma such as banging your elbow or dropping on to your knees and in the case of subacromial bursitis, falling on an outstretched hand. Infection is a less common cause of bursitis and normally only occurs in people who have a weakened immune system from other health issues. The infection can work its way to the bursa from a cut close to the bursa that has become infected, in these cases the bursitis is termed as septic bursitis. Certain health conditions can also trigger the development of bursitis such as rheumatoid arthritis and gout amongst others.
What does subacromial bursitis feel like?
The symptoms of bursitis vary depending on whether the bursitis is the result of injury or an underlying health condition or from infection. From normal overuse and injury the pain is normally a constant dull ache or burning pain over the shoulder joint that is aggravated by any touch, pressure or movement. There will normally be noticeable swelling unless the bursa lies deep under the skin, such as in the shoulder or hip, in these cases swelling might not be visible. Movement of the shoulder will be stiff especially in the mornings and after any activity involving the joint. All of these symptoms are experienced with septic bursitis with the addition of a high temperature of 38ºC or over and feverish chills. The skin around the affected joint will also appear to be red and will feel incredibly warm to the touch.
In cases of septic bursitis it is important that you seek medical attention. With injury induced bursitis if symptoms are still persisting after two weeks then report to your GP.
How long does subacromial bursitis take to heal?
The healing time frame of subacromial bursitis can vary from 2 weeks to 8 weeks and in some cases even longer than that depending on the severity of the injury or location. If the bursitis occurs near a joint that can be rested easily, the healing time will be greatly reduced. On the other hand, if it is in a joint that is regularly used, such as the shoulder then this perpetuates and flares the condition making healing a more lengthy process.
How will subacromial bursitis be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis but may be requested to check for any underlying health conditions that may have triggered the bursitis.
What treatment options are available for subacromial bursitis?
Your GP may prescribe a short course of anti-inflammatory painkillers to reduce and control the painful inflammation that occurs and antibiotics in cases of septic bursitis. Applying a covered ice pack to the area after the initial injury may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the icepack regularly for 10-15 minutes with intervals of 30 minutes. Where possible it is advisable to avoid all aggravating movements and postures, however complete rest is not advised as this can lead to weakness and further shortening of the muscle. Massage and manipulative therapies can help loosen the surrounding muscles and tendons of the affected joint, reducing the pressure over the bursa and allowing it to heal faster. If the bursitis is chronic and not responding to treatment then your GP may refer you for a corticosteroid injection which will reduce the inflammation levels and will in-turn reduce the pain levels experienced. Corticosteroid injections can have varied results. Surgery is a rare option when it comes to bursitis but occasionally it may be necessary for extremely chronic cases or to drain an infected bursa.
The underlying cause of the bursitis must be identified to prevent further reoccurrences. Failure to eliminate the cause will lead to future flare ups and a poor and slow recovery. Future occurrences can be prevented with the use of stretches and strengthening exercises which will help prevent your muscles from tightening up over the bursa. Pilates and yoga are very good for this providing the aggravating movements are avoided. Wearing joint supports such as knee pads or elbow supports may also reduce your likelihood of redeveloping bursitis.