Shoulder bursitis is an inflamed shoulder bursa. Your bursa is a fluid-filled sac that helps to reduce friction in your shoulder spaces.

You have several bursae within your shoulder. Your subacromial bursa is the most commonly inflamed of the shoulder bursa. Subacromial bursitis is a common cause of shoulder pain that is usually related to shoulder impingement of your bursa between your rotator cuff tendons and bone (acromion). Your subdeltoid bursa is a less commonly inflamed shoulder bursa.

What are the Symptoms of Shoulder Bursitis?

Shoulder bursitis commonly presents with the following symptoms:

  • Gradual onset of your shoulder symptoms over weeks or months.
  • Pain on the outside of your shoulder.
  • Pain may spread down your arm towards the elbow or wrist.
  • Pain made worse when lying on your affected shoulder.
  • Pain made worse when using your arm above your head.
  • Painful arc of movement – shoulder pain felt between 60 – 90° of the arm moving up and outwards.
  • When your arm is by your side there is minimal pain and above 90° relief of pain.
  • Shoulder pain with activities such as washing hair, reaching up to a high shelf in the cupboard.

The treatment for shoulder bursitis, or any form of bursitis, is aimed at controlling the inflammation of the bursa.

When shoulder bursitis or tendinitis stem from injury or overuse, initial treatment includes rest and other remedies to relieve inflammation. In cases of septic bursitis, in which the bursa is infected, antibiotics also must be used to prevent the spread of infection.

Rest. Avoid activities that will aggravate and inflame the shoulder bursa, such as throwing, lifting, pushing, and pulling.

Physical therapy. A doctor may prescribe physical therapy to stretch or strengthen shoulder muscles and improve posture, which may help treat the current bursitis and tendonitis and ward off future problems.

Non-steroidal anti-inflammatory drugs, or NSAIDs. Oral anti-inflammatory medications, such as aspirin, ibuprofen (e.g. Advil), naproxen (e.g. Aleve), and cox-2 inhibitors (e.g. Celebrex) can reduce swelling and inflammation and relieve pain associated with shoulder bursitis and tendonitis.

Topical medications. Topical medications come in the form of creams, sprays, gels, and patches and are applied directly to the skin over the painful joint.

Topical analgesics. The creams contain counterirritants, such as wintergreen and eucalyptus, which stimulate the nerve endings and distract the brain from joint pain. These creams are often sold over the counter and are available in most drug stores. Examples of brand names include Ben-Gay, Icy-Hot and Zostrix. Most can be used in combination with oral pain medications.

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Topical non-steriodal anti-inflammatory drugs, or NSAIDs. Like topical analgesics, topical NSAID creams should be applied directly to the painful shoulder. Topical medications containing the NSAID diclofenac have been found effective in treating isolated musculoskeletal pain. Topical NSAIDs are available only with a prescription and sold under the names Voltaren, Flector, Pennsaid, and Solaraze.

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Lidocaine patches. Lidocaine is a topical numbing agent that interrupts pain signals to the brain. Adhesive patches containing 5% lidocaine can be applied directly to the painful shoulder. These patches are available only with a prescription.

Topical medications may be a good choice for people with acromioclavicular osteoarthritis who want to minimize gastrointestinal side effects that oral medications sometimes cause. However, side effects are still possible. Patients should always discuss new medications with their doctor or pharmacist and read drug labels and instructions.

Aspiration to drain the bursa. Even when inflamed, the subacromial bursa usually does not swell significantly. However, in some cases a doctor may recommend aspiration, or draining, the bursa using a needle. A cortisone injection may be done at the same time.

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Corticosteroid injections. Symptoms that are not successfully treated with rest, NSAIDs, and/or physical therapy possibly may be relieved with corticosteroid injections. These injections may weaken the nearby tendons, so they should be used sparingly and only after more moderate treatments fail.

Antibiotics. Septic subacromial bursitis requires treatment with antibiotics. A doctor will prescribe different antibiotics depending on the type of microorganism triggering the infection (often staphylococcus aureus). Oral antibiotics are effective in treating most people with septic bursitis. More challenging cases may require hospitalization and antibiotics delivered intravenously.

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