Bursitis
Why Your Shoulder Hurts and What to Do
Your shoulder has tiny, fluid-filled cushions called bursae that help your tendons glide smoothly over bone. When one of these cushions, called the subacromial bursa, gets inflamed, it causes painful rubbing in the shoulder, often called shoulder bursitis or impingement.
This usually happens when the arm is lifted repeatedly overhead, narrowing the space between bones and pinching the bursa. Causes can include overuse, trauma, poor posture, or age-related changes.
Sometimes it comes on suddenly; other times, it builds slowly.
Subacromial impingement or bursitis?
The words 'bursitis' and 'impingement' describe different aspects of the same problem.
If you’ve been told you have “bursitis” or “impingement” in your shoulder, you might be wondering if they’re the same thing. While the terms describe different parts of the problem, they often happen together and cause very similar symptoms.
Subacromial impingement
Subacromial impingement happens when the tendons of your rotator cuff, the group of muscles that help you lift and rotate your arm , get pinched between the top of your arm bone and the bony tip of your shoulder, called the acromion.
Normally, these tendons slide smoothly when you move your shoulder. But if the space between the bones becomes too narrow, the tendons get squeezed every time you raise your arm. This repeated pinching can cause irritation, swelling, and ongoing pain, especially with overhead movements.
Causes of narrowing in the shoulder space can include:
- Overuse or repetitive activity - especially overhead sports or work.
- Shoulder injuries - such as falls or direct blows.
- Arthritis or bone changes - that alter the shape of the acromion over time.
If your pain doesn’t improve, your surgeon may confirm the diagnosis with a shoulder arthroscopy (a keyhole camera procedure).
Shoulder bursitis
Inside your shoulder, there’s a small fluid-filled cushion called the subacromial bursa. This bursa acts like a soft pad, helping tendons glide smoothly over the bone when you move your arm.
When this bursa becomes inflamed, a condition called subacromial bursitis, it can cause sharp or aching pain, especially when lifting your arm or lying on your shoulder.
Bursitis is often linked to impingement, since the same narrowing that pinches tendons can also irritate the bursa. Common causes include:
- Repetitive overhead activities — swimming, tennis, throwing sports, or weightlifting.
- Sudden shoulder injuries — such as knocks or falls.
- Poor posture — slouching or rounded shoulders can increase pressure in the joint.
- Age-related changes — natural wear and tear makes the shoulder more vulnerable.
Symptoms of subacromial impingement or bursitis
Shoulder bursitis and impingement are usually indicated by continual pain which inhibits everyday activities.
Symptoms of these conditions can include:
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Deep ache from your upper arm to shoulder, often present even at rest
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Pain when lying on that side, making sleep uncomfortable
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Difficulty reaching behind your head or back without pain
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Reduced movement or strength when lifting your arm
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Occasionally redness, warmth, or swelling if the shoulder’s especially irritated
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In advanced cases, motion may feel stiff or “frozen”
Individuals with subacromial bursitis may also experience shoulder swelling or redness. The shoulder may also induce pain if touched and feel 'hot'. If you have an advanced case of bursitis, you may also experience frozen shoulder, where movement of the shoulder becomes progressively limited.
Diagnosis of shoulder impingement /subacromial bursitis
A medical examination is the first step to diagnosing these issues.
Dr Oscar Brumby-Rendell will start with a discussion of your symptoms and a simple physical exam to check which movements hurt. They might perform tests like the “painful arc” or “Hawkins-Kennedy” to narrow it down. If needed, scans like X-rays, MRI, or ultrasound help rule out tendon tears or arthritis, though bursitis itself is often diagnosed by symptoms alone.
For this test, you must stand with out-turned hands and straight arms. Dr Brumby-Rendell will place his hands near your elbow and scapula (shoulder blade).
He will then move your arm in the outward direction and slowly raise it above your head. If you experience pain throughout this motion, you test positive.
Treatment options
Non-Surgical treatment for shoulder impingement and subacromial bursitis
Shoulder impingement and subacromial bursitis are initially treated via non-surgical means. These measures focus on avoiding activities that contribute to the condition (such as overhead sports), reducing swelling through anti-inflammatories, and completing prescribed shoulder exercises to strengthen and stretch shoulder muscles.
Cortisone injections may be administered under ultrasound control if bursitis is not improved via exercises. These injections directly introduce anti-inflammatory to the bursa.
Some conditions will be resolved quickly after one treatment, whereas more complicated conditions may require a prolonged healing period. Surgery may be required for some bursitis or impingement cases to heal correctly.
Surgical treatment: Shoulder arthroscopy /subacromial decompression
Pain caused by shoulder impingement and subacromial bursitis may be relieved via subacromial decompression. Dr Oscar Brumby-Rendell is highly qualified in implementing arthroscopic approaches and can perform this surgery with minimal invasiveness.
Is this procedure right for me?
You may be eligible for this procedure if you have been diagnosed with shoulder impingement and have seen no results after 4 to 6 months of non-surgical treatment.
Subacromial decompression increases space for tendons located below the acromion to correct shoulder impingement. Subacromial bursitis can also be treated by removing inflamed bursa tissue or the entire bursa (which will grow back).
During surgery
During this arthroscopic (keyhole) procedure, Dr Oscar Brumby-Rendell will make small incisions in the shoulder and insert a small camera and surgical instruments, allowing him to view the surgical site without creating a large wound.
In this procedure, the coracoacromial (CA) ligament is cut, and a portion of the acromion bone is shaven. This reduces muscle pressure, enables tendons and muscles of the rotator cuff to move easily, and promotes proper healing. Any bone spurs may also be removed.
This procedure has a quick healing period and minimal pain due to its arthroscopic measures. There is no need to stay overnight after this surgery. As this is not an open surgery, infection risks, tissue damage, and blood loss are minimised.
After your surgery, your wounds will be dressed, and you will wear a sling for arm comfort. Both the dressing and sling can generally be removed after 48 hours.
More post-operative information
Risks associated with subacromial decompression
Being a surgical procedure, there are specific risks associated with arthroscopic subacromial decompression. These may include:
- Infection
- Swelling
- Anaesthesia risks
- Nerve and blood vessel damage
- Continued shoulder pain post-surgery
- Continued symptoms, potentially requiring further surgery
Why See Dr Oscar Brumby-Rendell?
Dr Brumby-Rendell is an Adelaide-based orthopaedic surgeon specializing in upper limb issues, especially shoulder problems like bursitis. He’s known for using minimally invasive surgeries when needed and tailoring rehab programs for each patient. At the Adelaide Shoulder & Upper Limb Clinic, he ensures quick access, individualized care, and clear recovery planning.
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