Subacromial Bursitis

What is a Synovial Bursa?

A synovial bursa is a structure filled with a small amount of fluid located near joints in the human body. Its primary function is to reduce friction between muscles, tendons, ligaments, and bones during movement. Thanks to the synovial bursa, these tissues are protected from damage, facilitating smooth and painless joint motion. The human body contains many synovial bursae distributed in various areas, such as shoulders, elbows, hips, knees, and heels. In cases of trauma, overuse, or infection, the synovial bursa can become inflamed, leading to pain, swelling, and limited mobility in the affected joint.

How Does Bursitis Develop?

Bursitis can be caused by various factors. Frequent, repetitive movements or prolonged pressure on a joint can lead to irritation and inflammation of the synovial bursa. Examples include prolonged kneeling, common among gardeners or construction workers, and repetitive arm movements in athletes such as swimmers or tennis players. Another cause is direct trauma, such as a blow or fall on the joint, which can damage the bursa and trigger inflammation. Inflammatory conditions, such as rheumatoid arthritis or gout, and bacterial infections, particularly in the presence of an open wound near the joint, can also contribute.

Symptoms of Bursitis:

• Pain around the affected joint, which worsens with movement or pressure.
• Swelling and redness around the bursa.
• Restricted joint mobility.
• In cases of infection, fever and purulent discharge from the bursa area may occur.

Which Synovial Bursae Are Most Prone to Inflammation?

• Subacromial Bursa - Located beneath the acromion. Inflammation of this bursa often results from shoulder overuse, particularly in individuals performing repetitive arm movements, such as swimmers, painters, or tennis players.
• Olecranon Bursa - Located at the back of the elbow, between the skin and the ulna. Inflammation of this bursa, known as "student's elbow," can result from trauma, prolonged pressure, or infection.
• Trochanteric Bursa - Located on the lateral side of the hip near the greater trochanter. This condition is common among runners, older adults, and individuals with hip problems.
• Prepatellar and Infrapatellar Bursae - Susceptible to inflammation due to trauma or prolonged kneeling. These conditions are often referred to as "housemaid's knee" or "carpenter's knee."
• Retrocalcaneal Bursa - Located between the Achilles tendon and the heel bone. Inflammation frequently occurs in runners and individuals wearing improper footwear.

Causes of Subacromial Bursitis:

• Repeated overhead arm movements can lead to subacromial bursa overload. This is commonly seen in athletes such as swimmers, tennis players, and manual laborers like painters or carpenters.
• Sudden trauma, such as a fall on the shoulder or direct impact, can cause subacromial bursitis. It may result from both acute injuries and microtraumas due to prolonged stress.
• Subacromial impingement syndrome, where the rotator cuff tendons and the subacromial bursa are compressed by the acromion during shoulder movements, can lead to irritation and inflammation.
• Congenital or acquired structural abnormalities of the shoulder, such as osteophytes (bony growths) or anatomical anomalies, may increase friction and pressure on the subacromial bursa, causing inflammation.
• Diseases such as rheumatoid arthritis can lead to subacromial bursitis as part of a systemic inflammatory process.

Symptoms of Subacromial Bursitis:

• Shoulder pain, which worsens when lifting the arm.
• Pain that may radiate to the neck or arm.
• Restricted shoulder mobility.

How Long Does Subacromial Bursitis Last?

The duration of subacromial bursitis varies depending on the cause, severity of inflammation, and treatment applied. In cases of acute inflammation caused by sudden trauma or intense strain, symptoms may persist for several days to weeks. If bursitis results from repetitive overloads or chronic structural problems, it may last longer, from several weeks to even months. Proper treatment and modification of physical activity can significantly shorten recovery time and accelerate the return to normal function.

How Is Subacromial Bursitis Diagnosed?

Diagnosing subacromial bursitis involves a detailed medical history, physical examination, and additional diagnostic tests. The physician will inquire about symptoms such as shoulder pain, intensity, duration, and aggravating or relieving factors. Past injuries, physical activity, and occupational details will also be considered.

An orthopedic specialist will perform a physical examination of the shoulder, checking for tenderness, swelling, and redness. Range-of-motion and muscle strength tests will be conducted to assess mobility and identify any limitations.

Imaging studies may aid in diagnosis:

• X-ray - Helps rule out other causes of shoulder pain, such as fractures, osteophytes, or degenerative changes.
• Ultrasound - Evaluates the condition of the subacromial bursa and surrounding soft tissues.
• MRI - Provides a more detailed assessment of the subacromial bursa, tendons, and other shoulder structures.
• In some cases, aspiration of the bursa may be performed to collect fluid for laboratory analysis, aiding in the detection of infection or urate crystals (in cases of gout).

What Are the Treatment Options for Subacromial Bursitis?

Treatment of subacromial bursitis involves various approaches aimed at reducing pain and inflammation, improving shoulder function, and preventing recurrence. Rest and avoidance of activities that trigger pain, particularly overhead arm movements, are fundamental. Applying cold compresses to the shoulder area for 15-20 minutes several times a day can help alleviate pain. Physicians may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and relieve pain.

In cases of severe pain and inflammation, corticosteroid injections directly into the subacromial bursa may be recommended. This can quickly relieve pain and reduce inflammation. Short-term immobilization of the arm using a sling may be advised to allow the bursa time to heal. Physical therapy, including manual techniques, joint mobilizations, and exercises to strengthen shoulder muscles and improve range of motion, is crucial for recovery.

In rare cases, where conservative treatments fail, surgical procedures such as arthroscopy may be necessary to repair damaged tendons or remove calcifications. Each case is unique, so treatment plans should be tailored to individual needs and health conditions. Consultation with a skilled orthopedic specialist is essential to assess the condition and recommend appropriate treatment.

Can Subacromial Bursitis Resolve on Its Own?

Subacromial bursitis can resolve spontaneously, especially in mild cases caused by minor trauma or single instances of overload. However, recovery should be supported by:

• Avoiding activities that trigger pain and strain the shoulder.
• Using cold packs and taking nonsteroidal anti-inflammatory drugs.

Long-Term Approach:

• To prevent recurrence of subacromial bursitis, consider a long-term approach, including:
• Avoiding excessive joint strain.
• Regular strengthening and stretching exercises for shoulder muscles.
• Modifying workspaces and techniques for performing daily tasks.

Related Articles:
Learn about other possible shoulder injuries and conditions.

References:

• National Library of Medicine - Subacromial Bursitis - Taha Faruqi; Tara J. Rizvi. - 2023.
• MedicineNet - Shoulder Bursitis - Medical Author: William C. Shiel Jr., MD, FACP, FACR, Medical Editor: Melissa Conrad Stöppler, MD - 2023
• Springer - Inflammation of the subacromial bursa in chronic shoulder pain - Clinical and Experimental Forum - S. Santavirta, Y. T. Konttinen, I. Antti-Poika & D. Nordström - 1992