● Shoulder Condition

Subacromial Bursitis: Causes, Symptoms & Treatment

By Dr Raymond Yu · 15 October 2023

What Is Subacromial Bursitis?

The subacromial bursa is a fluid-filled sac that sits between the rotator cuff tendons and the acromion (the bony arch over the shoulder). Its role is to reduce friction between these structures. Subacromial bursitis occurs when this bursa becomes inflamed, causing pain and restricting shoulder movement.

Causes

Bursitis commonly results from:

Repetitive overhead activities — painting, swimming, throwing sports
Subacromial impingement — narrowing of the space between the rotator cuff and acromion
Rotator cuff tears — commonly coexist with bursitis
Acromial spurs — bony projections from the acromion that reduce available space
Acute injury or direct blow to the shoulder

Symptoms

Pain on the outer side and front of the shoulder
Pain with overhead activities, reaching behind the back, or lying on the affected shoulder
A painful arc of movement between 60–120 degrees of shoulder elevation
Night pain disturbing sleep

Diagnosis

Clinical examination and a targeted history are usually sufficient to diagnose bursitis. Ultrasound confirms the diagnosis and assesses for associated rotator cuff pathology. MRI may be ordered to provide a more complete assessment of the rotator cuff tendons.

Non-Surgical Treatment

The majority of subacromial bursitis cases resolve with conservative treatment:

Rest and activity modification
Physiotherapy — postural correction, rotator cuff and periscapular strengthening
NSAIDs and analgesics
Corticosteroid injection into the subacromial space — provides significant relief in most cases

Surgical Treatment

If symptoms persist for 3–6 months despite conservative treatment, arthroscopic subacromial decompression may be recommended. The procedure involves removing the inflamed bursa and shaving any bony spur from the acromion to increase the subacromial space. This is a day procedure and recovery is typically 2–4 months.