Subacromial Bursitis: The outermost aspect of shoulder contains a fluid filled sac called the subacromial bursa. When this sac gets inflamed due to any reason it results in pain in the shoulder. This pathological condition of the shoulder is called as Subacromial Bursitis.
This article deals with the following:
- Various Causes of Subacromial Bursitis
- Risk Factors of Subacromial Bursitis
- Symptoms Experienced by an Individual Affected with Subacromial Bursitis
- Different Diagnosis for Subacromial Bursitis
- Treatments Rendered for Subacromial Bursitis
- Exercise Routines for Subacromial Bursitis
How Do We Define Subacromial Bursitis?
Subacromial Bursitis is a pathological condition of the shoulder in which the subacromial bursa which is a fluid filled sac located on the outer aspect of the shoulder gets inflamed resulting in pain in the shoulder. The function of the subacromial bursa is to act as a lubricant and reduce friction between the bony prominence of acromion and the tendon of the supraspinatus muscle. With activities which involve frequent elevation of the arms, rotation of the shoulders, repetitive lifting, pushing or pulling, or lying on the shoulder causes friction and increases pressure on the bursa. This pressure may also be caused as a result of a direct fall to the shoulder or hand. When this pressure becomes too excessive for the bursa to handle then the inflammation of bursa develops causing Subacromial Bursitis.
Causes of Subacromial Bursitis
Subacromial Bursitis develops usually due to repetitive activities which places excessive strain on the subacromial bursa. The following activities increase strain on the subacromial bursa:
- Repetitive overhead activities
- Repetitive activities involving elevation of the arm
- Repetitive activities with the arm placed in front of the body
- Activities which involve rotating the shoulders
- Repetitive lifting, pushing, or pulling
At times, Subacromial Bursitis can also develop due to a direct blow to the shoulder or arm such as in a fall.
Certain sporting activities like baseball, swimming especially butterfly style, tennis, weightlifting also cause excessive strain on the subacromial bursa causing Subacromial Bursitis.
Risk Factors For Subacromial Bursitis
Some Of The Risk Factors Which May Predispose Individuals To Develop Subacromial Bursitis Are:
- Shoulder or neck Joint stiffness
- An unstable shoulder
- Bony abnormalities of the acromioclavicular joint
- Tightness especially of the rotator cuff and deltoid muscles
- Poor posture
- Inadequate warm up before performing a sporting activity
- Rotator cuff muscle weakness
- Inadequate rehabilitation after a previous injury to the shoulder
Symptoms Of Subacromial Bursitis
Individuals affected with Subacromial Bursitis usually experience pain on the top, front, and outer parts of the shoulder. There may be radiation of pain to the upper part of the arm and may go to the elbow.
If the inflammation is not significantly severe, individuals may only have stiffness or an aching sensation in the shoulder which tends to worsen after certain activities. These activities generally are repetitive lifting, pushing, pulling, doing activities which require placing the arm in front of the body.
With gradual progression of the condition, individuals start experiencing increasing pain with activities and may not be able to do their tasks appropriately. Affected individuals may also have pain with palpation of the shoulder.
Diagnosis of Subacromial Bursitis
To diagnose Subacromial Bursitis, a detailed history and physical examination will be done by the treating physician. An ultrasound of the shoulder is usually done to confirm the diagnosis of Subacromial Bursitis. An x-ray, MRI, or CT scan may be done to look at severity of the condition and to look for potential other disease conditions.
Treatment For Subacromial Bursitis
Subacromial Bursitis can be treated conservatively with the use of physical therapy using ultrasound and cryotherapy. In certain instances where physical therapy is not providing adequate relief then steroid injections maybe utilized. In case, if all these treatments fail to provide adequate relief then surgery is the route taken for relief of symptoms using an arthroscope to visualize the damaged structures and repair them. The most vital treatment for Subacromial Bursitis is adequate rest to the shoulder and doing exercises diligently.
Exercises For Subacromial Bursitis
The exercises detailed below are usually prescribed for individuals diagnosed with Subacromial Bursitis. The affected individual needs to consult with the physical therapist before starting these exercises. It should be done at least three times a day and should not be done if there is an exacerbation of the pain. The physical therapist can appropriately advise as to when to start the exercises and when to advance the exercises.
Shoulder Blade Squeeze: To start this exercise, you need to stand or sit keeping the back straight. The chin needs to be slightly tucked in and the shoulders should be back a bit. Now, slowly start squeezing the shoulder blades as hard and far as you can do without aggravating the pain. Hold the position for about 6 seconds and repeat the exercise about 15 times.
Pendular Exercises: To start this exercise, start by leaning forwards with the unaffected hand placed on a table for support. Keeping the back straight and shoulders relaxed gently start swinging the injured arm in the forward and backward direction as far as possible without increasing symptoms. This needs to be done at least 10 times. Repeat the exercise but now swing the arm sideways.
Pendular Circles: To start this exercise, lean in the forward direction with the unaffected arm placed on a table for support. With the back kept straight and relaxing the shoulders, start swinging the arms gently in circles as far as possible without aggravating the symptoms, first clockwise and then anticlockwise. Do this for about 10 times in each direction.
Foam Roller Stretch: For this exercise you need to place a foam roller under the back as shown in the picture. Breathe normally while keeping the back and neck in a relaxed position. You need to hold this position for about a minute if it does not cause any increase in symptoms.