Subacromial Bursitis
Subacromial bursitis is inflammation of the small fluid-filled sac (bursa) that helps shoulder tendons move smoothly. It can cause pain and reduced movement, often worsened by lifting the arm, reaching overhead, or lying on the affected side. Common causes include repetitive overhead activity, trauma, or coexisting shoulder conditions like rotator cuff tendinopathy.
Overview | Symptoms & Causes | Diagnosis | Treatment Options
What is Subacromial Bursitis?
The shoulder is a complex joint, surrounded by muscles, tendons, and small fluid-filled sacs called bursae. These bursae act as cushions, reducing friction between moving tissues and helping the shoulder move smoothly. The subacromial bursa sits beneath the acromion (the bony tip of the shoulder blade) and above the rotator cuff tendons, providing a gliding surface during arm movements.
Subacromial bursitis occurs when this bursa becomes inflamed, often due to repetitive overhead activity, trauma, or irritation from nearby tendons such as the rotator cuff. The inflammation can cause pain, swelling, and stiffness, making it uncomfortable to lift the arm, reach overhead, or perform everyday tasks. Over time, chronic bursitis can affect shoulder function, particularly if underlying tendon issues or biomechanical problems are also present.
Understanding Subacromial Bursitis
Subacromial bursitis symptoms often develop gradually and can vary in intensity. Common signs include:
- Pain on the outer side or top of the shoulder, especially when lifting the arm overhead or reaching out.
- Night-time discomfort, which can make it difficult to sleep on the affected side.
- Weakness or difficulty performing activities that involve lifting, pushing, or carrying.
- Tenderness when pressing over the bursa area at the top and outer shoulder.
- Occasional swelling or warmth if inflammation is significant.
Pain typically worsens with activity and eases with rest, but chronic bursitis can cause persistent discomfort, making everyday movements challenging.
Causes & Risk Factors
Subacromial bursitis develops when the bursa in the shoulder becomes irritated or inflamed. Several factors can increase the risk, often related to repetitive use, injury, or underlying tendon problems.
| Repetitive overhead activities | Sports like tennis, swimming, or work involving lifting, reaching, or overhead tasks can repeatedly compress the bursa. |
| Rotator cuff tendon problems | Tendon irritation, degeneration, or tears can inflame the bursa due to friction and abnormal shoulder mechanics. |
| Shoulder injuries or trauma | Falls, direct blows, or sudden shoulder movements may damage the bursa or surrounding structures. |
| Age-related degeneration | As we age, tendons and bursae become less resilient, making inflammation more likely. |
Diagnosing Subacromial Bursitis
Diagnosis of subacromial bursitis is usually based on a careful clinical assessment, supported by imaging when needed. Your clinician will examine the shoulder, checking for tenderness, pain with specific movements, and any limitation in range of motion.
| Ultrasound | A shoulder ultrasound is a quick, non-invasive test that can show swelling or fluid in the subacromial bursa. It can also identify inflammation in nearby tendons, helping confirm the cause of pain. |
| MRI | An MRI is usually reserved for persistent or complex cases. It provides detailed images of the shoulder’s soft tissues, allowing evaluation of the rotator cuff tendons, the bursa, and surrounding structures. MRI is especially useful if other shoulder conditions are suspected or if symptoms do not improve with initial treatment. |
Treatment Options
The main goal of treatment for subacromial bursitis is to reduce inflammation, relieve pain, and restore normal shoulder movement.
| Rest and activity modification | Temporarily avoiding activities that aggravate the shoulder helps reduce irritation and allows the bursa to settle. |
| Physiotherapy | A tailored exercise programme focuses on stretching tight muscles and strengthening the rotator cuff and shoulder stabilisers. This improves shoulder mechanics and reduces stress on the bursa. |
| Medications | Short courses of non-steroidal anti-inflammatory drugs (NSAIDs) can ease pain and inflammation. |
| Steroid injection | For persistent symptoms, a targeted injection can quickly reduce inflammation in the bursa and provide significant relief. |
Most cases respond well to these conservative measures. In rare or chronic cases where symptoms continue, further specialist evaluation may be required.
How can Lanthorn help?
Shoulder Ultrasound - £300
We use high-resolution ultrasound as the first step to examine your shoulder. This non-invasive scan can detect inflammation or fluid in the subacromial bursa and assess the health of nearby rotator cuff tendons. It helps confirm the diagnosis and guides decisions about treatment.
Ultrasound-guided Steroid Injection - £450
For persistent pain, a targeted steroid injection can be administered directly into the inflamed bursa under ultrasound guidance. This ensures accurate delivery, reduces inflammation, and often provides rapid pain relief, allowing you to resume physiotherapy and daily activities more comfortably.
Shoulder MRI - £350
If more detailed information is needed, an MRI provides a comprehensive view of the shoulder’s soft tissues. It can show subtle tendon tears, chronic bursitis changes, or other conditions that may affect your treatment plan.
