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Understanding Shoulder Bursitis and Impingement in Sports
For athletes in sports that demand repetitive overhead motion—like swimming, baseball, tennis, and weightlifting—shoulder pain is a frequent and often debilitating complaint. While rotator cuff injuries get much of the attention, a common culprit behind this pain is shoulder bursitis. The bursa is a small, fluid-filled sac that acts as a cushion, reducing friction between the bones, tendons, and muscles of the shoulder. When the subacromial bursa (located below the acromion bone) becomes inflamed, it swells, leading to a painful condition that often accompanies shoulder impingement. From my clinical experience, athletes often describe a sharp, catching pain when raising their arm, a classic sign that the inflamed bursa is being pinched in the tight space of the shoulder joint.
Personal Analysis: We see shoulder bursitis not as an isolated diagnosis, but as a symptom of an underlying mechanical problem. The bursa itself is rarely the primary issue; it becomes inflamed because of something else—poor posture, muscle imbalance, rotator cuff weakness, or faulty mechanics. Therefore, effective treatment cannot just focus on calming the bursa with an injection. True, long-term resolution requires a thorough biomechanical assessment to identify and correct the root cause of the impingement.[1]
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Bursitis involves inflammation of the bursa, a sac that cushions the shoulder joint. |
This article details the causes, symptoms, and comprehensive treatment approach for shoulder bursitis in athletes, focusing on both immediate relief and long-term prevention.
Causes and Symptoms in Overhead Athletes
Shoulder bursitis is fundamentally an overuse injury. Repetitive overhead motions can lead to irritation and inflammation of the bursa. The condition is often intertwined with shoulder impingement syndrome, where the space between the acromion and the rotator cuff tendons narrows, pinching the bursa.
Common causes and contributing factors include:
- Repetitive Overhead Activity: The primary cause in athletes involved in sports like swimming, throwing, and tennis.
- Rotator Cuff Weakness: Weak rotator cuff muscles can allow the head of the humerus to ride up, narrowing the subacromial space and causing impingement.
- Poor Scapular Mechanics: Improper movement of the shoulder blade can alter the normal biomechanics of the shoulder, leading to irritation.
- Direct Trauma: A direct fall or blow to the shoulder can cause acute traumatic bursitis.
The hallmark symptoms of shoulder bursitis include:[2]
- Pain on the Top and Outer Side of the Shoulder.
- Sharp Pain with Overhead Movements, such as reaching up or lifting the arm to the side.
- Night Pain, especially when lying on the affected shoulder.
- Tenderness when pressing on the top of the shoulder.
This is similar to a rope fraying as it's pulled repeatedly over a sharp edge. The rope is the rotator cuff tendon, the sharp edge is the acromion bone, and the bursa is the protective padding in between. Eventually, the padding (bursa) wears down and becomes inflamed from the constant friction, causing pain with every movement.
Diagnosis and Treatment Strategies
The diagnosis of shoulder bursitis is primarily clinical, based on the athlete's history and a thorough physical examination.
| Component | Description |
|---|---|
| Physical Exam | The clinician will perform specific impingement tests (like the Neer and Hawkins tests) that compress the subacromial space to reproduce the pain. They will also assess rotator cuff strength and range of motion. |
| Imaging | X-rays may be taken to rule out bone spurs or arthritis. An ultrasound or MRI can visualize the inflamed bursa and assess the health of the rotator cuff tendons, which are often involved.[3] |
| Diagnostic Injection | Injecting a local anesthetic into the subacromial space can be diagnostic. If the pain is significantly relieved, it confirms that the bursa is a major source of the pain. |
Treatment is typically conservative and focuses on reducing inflammation and correcting the underlying mechanical issues.
- Activity Modification: The first step is to avoid the aggravating overhead movements.
- Anti-inflammatory Measures: Ice and nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation in the acute phase.
- Physical Therapy: This is the cornerstone of treatment. A therapist will work on strengthening the rotator cuff and scapular stabilizing muscles, improving posture, and restoring proper shoulder biomechanics.
- Corticosteroid Injection: If pain is severe and limiting participation in physical therapy, a corticosteroid injection into the bursa can provide powerful, short-term anti-inflammatory relief, creating a window of opportunity to progress with rehabilitation.[4]
Personal Opinion: We believe a corticosteroid injection should be viewed as a tool, not a cure. It's excellent for "putting out the fire" of inflammation, but it does nothing to fix the faulty mechanics that started the fire. An athlete who relies solely on injections without committing to the corrective exercises prescribed in physical therapy is highly likely to have the pain return once the medication wears off. A comprehensive approach is always best.
In conclusion, shoulder bursitis is a common and painful sports injury for overhead athletes, but it is highly treatable with a comprehensive approach. The key to successful recovery is to look beyond the inflamed bursa and address the root causes of the shoulder impingement. Through a combination of rest, targeted physical therapy to improve strength and mechanics, and judicious use of anti-inflammatory treatments, athletes can overcome this condition. Effective shoulder rehabilitation not only resolves the current pain but also provides the biomechanical foundation to prevent recurrence, ensuring a durable and safe return to sport.
