Shoulder Bursitis & Impingement - Diagnosis & Treatment in Adelaide
Dr Arthur Turow, Shoulder SurgeonShoulder bursitis, also known as impingement, is caused by compression of the rotator cuff tendons and soft tissues at the top of your shoulder against the top of the shoulder blade. Dr Arthur Turow is an orthopaedic surgeon who specialises in shoulder and upper limb conditions. He offers expert diagnosis, treatment guidance and advanced surgical options, including shoulder arthroscopy for treatment of shoulder bursitis, delivering best practice care to patients with shoulder bursitis and impingement.
What is shoulder bursitis & impingement?
Shoulder impingement, also known as subacromial impingement or shoulder bursitis, is caused by compression or pinching of the rotator cuff tendons and soft tissues at the top of your shoulder against the top of the shoulder blade. It occurs when there is reduced space between the acromion (a bony projection of the shoulder blade) and the rotator cuff tendons and bursa (fluid-filled sac that acts as a cushion at the top of the shoulder). This compression can lead to pain, inflammation and limited range of motion.
What causes shoulder bursitis?
The main reasons why your shoulder may develop shoulder bursitis and impingement include:
Structural factors: Certain anatomical variations, such as a bony outgrowth of your acromion, also known as a hooked acromion, a downward-pointing acromion, or a generally narrow space beneath the acromion, can cause shoulder impingement. However, the main diving factor for shoulder impingement is inflammation or injury of the rotator cuff. The rotator cuff consists of four muscles and their tendons that encircle the shoulder joint. The rotator cuff provides stability to your shoulder and helps your shoulder move.
- Repetitive overhead activities: Activities that involve repetitive overhead motions or excessive use of the shoulder joint can contribute to the development of shoulder impingement. This may include continuous work exposure, throwing, lifting heavy objects or taking part in specific sports.
- Muscle imbalances and weakness: Imbalances in the muscles surrounding the shoulder joint and your shoulder blade (scapula) can lead to abnormal movement. This can change the way your shoulder sits at rests against your chest wall and how it moves. This, in turn, can increase the risk of shoulder impingement.
Subacromial Bursa
The subacromial bursa is a fluid filled cavity that lies under the acromion and the deltoid muscle. It allows the underlying rotator cuff tendons to slide smoothly past the acromion.
Subacromial Bursitis
The subacromial bursa may become inflamed and painful in conditions affecting the shoulder, such as rotator cuff tears, external compression or muscle imbalance.
Acromial Spur
The subacromial bursa may become inflamed and painful in cases of extrinsic compression of the rotator cuff muscles, such as an acromial spur.
Shoulder Bursitis Treatment Options in Adelaide
Non-surgical Management
The majority of shoulder impingement (around 80%) can be effectively treated without surgery. Everyone’s shoulder and expectations are different, so there is no one thing that works best. Treatment should be tailored to your specific needs. Broadly, the best way to treat shoulder impingement is to combine treatments. Research has shown that when you use different treatment modalities concurrently, the benefits are much larger than just sticking to one thing. Some of the options are outlined below:
Rest and activity modification
This is a good starting point. Avoiding or modifying activities that worsen your pain can help you to manage your symptoms temporarily. You may find that wearing a shoulder sling can help.
Pain management
It is best to stick to simple pain relief, such as Paracetamol (Panadol) or nonsteroidal anti-inflammatories (NSAIDs; Nurofen). Steroid injections can be considered in certain situations depending on your presentation
Exercise
Physiotherapy can help to strengthen and regain function. A dedicated physiotherapist would usually work with you by targeting the five pillars of shoulder rehabilitation: (1) Heating and/or cooling, (2) Massage and manual therapy, (3) Range of motion work, (4) Flexibility as well as stretching and (5) strengthening. Your physiotherapist may also suggest shoulder taping, which could help you to restore normal shoulder dynamics.
Acupuncture/ Dry Needling
Some patients may see benefit from acupuncture. The main therapeutic effect from this is from activation of sensory receptors. This can stimulate your central nervous system to naturally produce pain killers (endogenous opioid peptides), leading to reduction of pain.
Shockwave Therapy
This involves application of high-energy acoustic waves to your shoulder. It can promote your body to start a healing or repair process. This may particularly be beneficial if the reason you have shoulder impingement is due to extensive inflammation of your rotator cuff, such as calcific tendonitis.
Laser therapy
This is also known as cold laser or low-level laser therapy. It uses a specific type of light that may help to promote healing and inhibit pain naturally.
Surgical Treatment
In some cases, surgery on your shoulder may be necessary, sometimes known as shoulder decompression surgery. If you have tried several non-operative treatments and are still experiencing pain and limited use of your shoulder, it is best to have your shoulder assessed by a specialist. Surgery is done arthroscopically (key-hole) and is aimed at creating more space in the shoulder joint by removing any bone spurs or any excess inflammation. In addition, if the reason you have continued shoulder impingement is damage or injury to your rotator cuff, surgery may be better suited at treating this rather than persisting with non-surgical treatment.
Shoulder Arthroscopy
What to expect after decompression surgery?
During shoulder decompression surgery, specialised arthroscopic instruments are used to remove part of your bursa. In addition, removal of bone spurs or other tissue may be needed depending on the cause of the bursitis. After surgery, you will be provided with a shoulder sling to assist your recovery. The sling can be removed after 1-2 weeks following surgery and early range of motion can be commenced with your physiotherapy team. An approximate timeline of your recovery is outlined below:
Stage 1 – Pain Management
- In the first 1-2 weeks you are provided with a sling for comfort
- You can start on early range of motion straight after surgery
Stage 2 – Increase Range of Motion
- This stage covers weeks 2-6
- The sling is gradually weaned
- You start on active range of motion
- Low-resistance strengthening is introduced
Stage 3 – Strengthening & Return to full activities
- After weeks 4-6 the focus is on strengthening
- Resistance training is increased
- You can return to swimming and gradually to full activities
Why Choose Dr Arthur Turow for Shoulder Bursitis & Impingement in Adelaide
When it comes to your shoulder treatment, choosing an experienced and trusted specialist is essential. Dr. Arthur Turow is an Australian-trained orthopedic surgeon providing a high level of expertise in diagnosing and treating complex shoulder conditions.
- Shoulder Specialist: Subspecialty training in shoulder and upper limb surgery
- Advanced Techniques: Arthroscopic surgery tailored to each patient
- Local Expertise: Accessible care across Adelaide and South Australia, including Yorke Peninsula, Gawler and Mt Barker
- Patient-Centred Care: Personalised treatment tailored for every patient
- Recognised Training: Fellow of the Royal Australasian College of Surgeons (FRACS) with additional memberships of the Australian Orthopaedic Association (AOA) and Australian Medical Association (AMA)
Frequently Asked Questions
What causes shoulder bursitis?
Certain anatomical variations, such as a bony outgrowth of your acromion, repetitive overhead activities, muscle imbalances and weakness or inflammatory conditions such as rheumatoid arthritis can all contribute to bursa irritation.
How do I know if I have a shoulder bursitis?
The symptoms of shoulder bursitis can vary depending on why you have developed shoulder bursitis. Most commonly, you may have pain at the tip of the shoulder with shoulder abduction (moving the arm away from your body). Common symptoms you may experience include:
Pain: Typically felt at the tip or the front of the shoulder. Your pain may get worse with shoulder activity, especially with moving your shoulder above your head. Sometimes you can also have persistent pain with prolonged sitting. In some cases, your pain could also persist throughout the night and make finding a comfortable position in bed difficult.
Weakness: Difficulty or weakness in performing certain shoulder movements or lifting objects can be part of shoulder impingement. This is particularly the case if the underlying case of impingement is a tear in your rotator cuff tear. You may find that lifting objects or certain movements or sports are tricky to do.
Limited range of motion: Reduced ability to move your shoulder usually gives hand in hand with pain and weakness. This is particularly the case with activities involving abduction (raising the arm to the side) and external rotation (rotating the arm outward) of your shoulder.
Can shoulder bursitis and impingement be reversed?
Patients frequently ask “Will my shoulder impingement ever go away?” or “Can shoulder impingement be reversed?”. The answer to those questions is frequently not straight forward. This is because the reasons why you may have shoulder bursitis are often multi-factorial. You may have developed bursitis and impingement due to an injury, altered scapular movement, posture, torn muscles or tendons, calcific tendonitis, degeneration or other causes. There are however some things that can be done to treat your pain and improve your shoulder function.
What is recovery like after decompression surgery?
Most patients need to wear a sling for 1-2 weeks and begin physiotherapy soon after surgery. Full recovery and strength often take up to two months, though this can vary, depending on the cause of the bursitis and your activity level.