Shoulder Conditions

Shoulder Impingement (Bursitis)

Shoulder Impingement & Bursitis: Causes, Symptoms, Diagnosis and Treatment Options

Shoulder impingement is a frequent cause of shoulder pain, particularly during lifting or overhead activities. It occurs when the soft tissues within the shoulder become irritated or compressed during movement, leading to inflammation, pain, and reduced shoulder function.

The bursa (a thin smooth fluid filled sac between the rotator cuff and the bone above) is the key structure compressed and when this becomes inflamed it is known as bursitis

Shoulder impingement often develops gradually and may be associated with rotator cuff degradation or changes in shoulder structure such as development of a bone spur over time.

It is rarely the result of a single accident or injury. Early assessment can help identify these features and guide the most appropriate treatment.

What Is Shoulder Impingement and Subacromial Bursitis?

The shoulder joint relies on smooth movement between several closely related structures, including the rotator cuff tendons, the subacromial bursa, and the surrounding bones of the shoulder.

The subacromial bursa is a thin, fluid-filled sac located above the rotator cuff tendons. Its role is to reduce friction as the arm moves. Shoulder impingement occurs when this space becomes narrowed or irritated, causing the bursa and rotator cuff tendons to be compressed during arm elevation. Repeated irritation can lead to inflammation of the bursa (bursitis), rotator cuff tendon irritation, pain, and weakness.

What Causes Shoulder Impingement and Bursitis?

Shoulder impingement and bursitis usually develop due to a combination of mechanical and lifestyle factors.

Common contributing factors include:

Repetitive overhead activity or heavy lifting
Rotator cuff weakness or degeneration and early tearing
Bone spurs on the underside of the acromion
Poor shoulder mechanics or muscle imbalance
Poor posture, particularly stooped shoulders

In many cases, shoulder impingement forms part of a broader spectrum of shoulder conditions, particularly rotator cuff disease.

Conditions Mimicking Impingement

The clinical problem of pain with repetitive or overhead use of the shoulder can also arise from other structural issues in the shoulder and may mimic impingement from bursitis and subacromial spurring. This is particularly the case in active young people (usually those less than 40 years of age) still playing sport or weights training. AC joint inflammation, bicep tendon disease or internal labral tears for example can result in similar symptoms and careful diagnosis is important. In older people shoulder joint arthritis can mimic impingement in its early stages. Impingement pain is not felt below the elbow, nor behind the shoulder over the shoulder blade area.

Symptoms of Shoulder Impingement and Bursitis

Symptoms can vary in severity and often worsen gradually over time, particularly if the aggravating activity continues.

Common symptoms include:

Pain at the front or side of the shoulder
Pain when lifting the arm, particularly above shoulder height
Discomfort when reaching behind the back
Night-time pain, especially when lying on the affected shoulder
Reduced shoulder strength

In early stages, pain may only occur during activity. As inflammation progresses, symptoms may become more persistent and interfere with sleep, work, and daily activities.

How Shoulder Impingement and Bursitis Are Diagnosed

Diagnosis begins with a thorough clinical assessment, including a detailed history and physical examination. This allows assessment of shoulder movement, strength, posture, and areas of tenderness.

Imaging may be used to support the diagnosis and assess contributing factors:

1 X-rays

X-rays to evaluate bone shape, joint alignment, and bone spurs

2 Ultrasound and MRI

Ultrasound or MRI to assess the rotator cuff tendons and subacromial bursa

Non-Surgical Treatment for Shoulder Impingement and Bursitis

Most cases of shoulder impingement can be managed without surgery. Initial treatment focuses on reducing inflammation and improving shoulder mechanics.

Treatment decisions are guided by factors such as:

Activity modification to avoid aggravating movements
Physiotherapy to improve posture, rotator cuff strength, and movement patterns
Anti-inflammatory medication where appropriate
Ice or other pain-relief strategies
Corticosteroid injections in selected cases to reduce inflammation (try to avoid if there is degradation of the rotator cuff)

While these treatments do not alter shoulder anatomy, many patients experience improvement in pain and function. Most impingement pain will resolve with careful management unless significant structural issues exist such as rotator cuff deterioration or large bone spurs severely reducing the subacromial space.

When Should Surgery be Considered for Shoulder Impingement

Surgical treatment may be considered when symptoms persist despite appropriate non-operative management and continue to limit daily activities, work, or sleep.

Generally 3 to 6 months of non-surgical treatment is needed before considering surgery.

Arthroscopic Shoulder Decompression Surgery: When surgery is recommended, it is typically performed using a minimally invasive arthroscopic (keyhole) approach.

This procedure may involve:

Removal of inflamed
bursal tissue

Removal of bone spurs
contributing to impingement

Assessment and treatment of associated rotator cuff, AC joint or biceps tendon pathology

Arthroscopic surgery allows detailed visualisation of the shoulder joint while minimising disruption to surrounding tissues.

Recovery and Rehabilitation After Shoulder Impingement Treatment

Recovery depends on the treatments performed and individual factors such as shoulder condition and activity demands.

Rehabilitation typically includes:

Recovery from simple removal of a spur and clean up of the bursa is generally very quick. Your rehabilitation program is tailored to your shoulder condition and recovery goals.

Specialist Assessment for Shoulder Impingement and Bursitis

Shoulder impingement can present differently from person to person. Careful evaluation is important to determine whether symptoms are due to impingement/ bursitis or other shoulder conditions.

A specialist review may be helpful if:

Dr Richard Dallalana provides specialist assessment and management of shoulder impingement and bursitis, guiding treatment decisions based on symptoms, imaging findings, and functional needs. A thorough assessment can help clarify the diagnosis and guide appropriate management.

If you’re experiencing ongoing pain, stiffness, or reduced movement that is affecting your daily activities or quality of life, a thorough orthopaedic assessment can help determine the cause and guide the most appropriate treatment options for your situation.

Shoulder Conditions

Shoulder Impingement (Bursitis)