SUBACROMIAL BURSITIS

Subacromial bursitis is a condition characterized by tissue damage and inflammation of the subacromial bursa (a small fluid filled sac located beneath the bony prominence at the top / outer aspect of the shoulder) causing pain in the shoulder

Beneath the acromion lies a bursa known as the subacromial bursa . A bursa is a small sac filled with lubricating fluid and is designed to reduce friction between adjacent soft tissue or bony layers. The subacromial bursa reduces friction between the bony prominence of the acromion (above the bursa) and the tendon of the supraspinatus muscle (which attaches to the upper aspect of the humeral head) below the bursa.

During certain activities, such as arm elevation, rotating the shoulder, lifting, pushing or pulling or lying on the shoulder, friction and compressive forces are placed on the subacromial bursa. Pressure may also be placed on the subacromial bursa following a direct impact or fall onto the point of the shoulder, elbow or outstretched hand. When these forces are excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur. When this occurs, the condition is known as subacromial bursitis.

WHAT ARE THE CAUSES?

Repetitive or prolonged overhead activities

Repetitive or prolonged arm elevation activities

Repetitive or prolonged use of the arm in front of the body

Activities involving rotation of the shoulder

Lifting (especially overhead)

Excessive pushing or pulling activities (placing strain on the bursa via the supraspinatus tendon)

Putting weight through the affected arm

Lying on the affected side

Signs and symptoms of subacromial bursitis

Patients with this condition typically experience pain at the top, front, back or outer aspect of the shoulder. Pain may also radiate into the upper arm as far as the elbow. In less severe cases, patients may only experience an ache or stiffness in the shoulder that increases with rest following activities placing strain on the bursa. These activities typically include arm elevation activities, use of the arm in front of the body or overhead, shoulder rotating activities, lifting, pushing or pulling, placing weight through the arm or lying on the affected side. The pain associated with this condition may also warm up with activity in the initial stages of injury.

As the condition progresses, patients may experience symptoms that increase during activity or sport, affecting performance. Patients with subacromial bursitis may also experience pain on firmly touching the top / outer aspect of the shoulder. A painful arc of arm elevation and / or a feeling of shoulder weakness may also be present particularly when attempting to lift or elevate the arm overhead.

Prognosis of subacromial bursitis

Most patients with this condition heal well with appropriate physiotherapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take many months in those who have had their condition for a long period of time, or, in those with other associated injuries such as rotator cuff pathology. Early physiotherapy treatment is vital to hasten recovery in all patients with subacromial bursitis.

Physiotherapy for subacromial bursitis

Physiotherapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence in all patients with this condition. Treatment may comprise:

• soft tissue massage
• dry needling
• electrotherapy (e.g. ultrasound, TENS etc)
• stretches
• joint mobilization (of the shoulder, neck and upper back)
• joint manipulation
• heat or cold treatment
• the use of a sling
• progressive exercises to improve strength, flexibility, posture and scapula stability
• correction of abnormal biomechanics or technique
• education
• postural taping
• the use of a postural support
• anti-inflammatory advice
• activity modification advice
• a gradual return to activity programme

Lying Dumbbell External Rotation

External rotations strengthen your infraspinatus and teres minor muscles. You can feel the infraspinatus if you touch the posterior, lower surface of your shoulder blade. The teres minor muscle lies on the outermost, lower border of your shoulder blade. Both muscles attach to the lateral, uppermost end of your arm bone.

This exercise is performed by holding a light dumbbell in the hand that's on the same side as your injured shoulder, then lying on the opposite side of your body. Bend your elbow to 90 degrees, draping your forearm across your abdomen; keep your injured upper arm and elbow tucked against your ribs. To work your external rotators, raise the dumbbell, rotating your arm outward as much as possible; repeat for three sets of 15 repetitions.

Lying Dumbbell Internal Rotation

This exercise engages the subscapularis muscle, which lies on the anterior surface, or underside of the scapula, and attaches to the anterior, upper end of your arm bone. First, lie flat on your back, holding a light dumbbell in the hand that's on the same side as your injured shoulder. Bend your elbow to 90 degrees, tucking your upper arm against your rib cage with your forearm rotated out to the side as much as possible. To work your internal rotator, pull the dumbbell toward you and across your abdomen; repeat for three sets of 15 repetitions.

Lateral Raises

Performing lateral raises with a very light dumbbell enables you to focus more on the supraspinatus muscle, instead of the deltoid muscle. You may do this exercise standing up or sitting down. Begin by holding the dumbbell with the hand that's on the same side as the injured shoulder. Align your entire arm along the side of your body; keep a slight bend in your elbow. Raise the dumbbell out to your side until your arm is parallel to the floor, holding the contraction for 3 seconds; repeat for three sets of 15 reps.