What is Shoulder Impingement and Bursitis?
Shoulder impingement and bursitis are common conditions that cause shoulder pain, inflammation, and reduced movement. They often occur together because both involve structures within the subacromial space of the shoulder.
Shoulder impingement occurs when the tendons of the rotator cuff and surrounding soft tissues become compressed or pinched between the acromion (part of the shoulder blade) and the upper arm bone during shoulder movement. Repeated compression can lead to irritation and inflammation.
Bursitis refers to inflammation of the bursa, a small fluid-filled sac that cushions and reduces friction between bones, tendons, and muscles. In the shoulder, the subacromial bursa helps the rotator cuff move smoothly beneath the acromion. When this bursa becomes inflamed, it may cause pain and further limit movement.
These conditions commonly affect athletes, active individuals, and people who perform repetitive overhead activities.
What are the Causes of Shoulder Impingement and Bursitis?
Several factors may contribute to the development of shoulder impingement and bursitis. Common causes include:
- Repetitive overhead activities such as throwing, swimming, painting, or lifting
- Overuse injuries from sports or occupational activities
- Rotator cuff inflammation or tendinitis
- Bone spurs beneath the acromion causing mechanical irritation
- Poor posture leading to altered shoulder mechanics
- Shoulder instability or muscle imbalance
- Age-related degeneration of shoulder tissues
- Previous shoulder injuries or trauma
- Repetitive friction between the rotator cuff and surrounding structures
- Inflammatory conditions affecting joints and soft tissues
These factors can narrow the space within the shoulder, increasing pressure on the tendons and bursa.
What are the Symptoms of Shoulder Impingement and Bursitis?
Symptoms may develop gradually or worsen over time depending on the severity of inflammation and tissue irritation. Common symptoms include:
- Pain on the outer or front part of the shoulder
- Pain that worsens with overhead movement
- Difficulty lifting the arm above shoulder level
- Shoulder weakness
- Pain during reaching, throwing, or lifting activities
- Night pain, especially when lying on the affected side
- Reduced range of motion
- Clicking or catching sensations during movement
- Tenderness around the shoulder region
- Stiffness and difficulty performing daily activities
Symptoms may become more noticeable with repetitive activity or prolonged use.
How are Shoulder Impingement and Bursitis Diagnosed?
Diagnosis begins with a detailed medical history and physical examination. The physician evaluates symptoms, activity level, previous injuries, and shoulder function.
During the examination, shoulder range of motion, strength, and areas of tenderness are assessed. Specific clinical tests may be performed to reproduce symptoms and identify impingement.
Imaging studies may help confirm the diagnosis and rule out associated conditions. X-rays can identify bone spurs, arthritis, or structural abnormalities. MRI or ultrasound imaging may be used to evaluate inflammation of the bursa, rotator cuff tendons, or other soft tissue injuries.
Additional imaging may be recommended if a rotator cuff tear or other shoulder pathology is suspected.
What are the Treatment Options for Shoulder Impingement and Bursitis?
Treatment depends on symptom severity, underlying causes, and activity demands. Many patients improve with conservative treatment measures.
Common treatment options include:
- Activity modification and temporary avoidance of aggravating activities
- Rest and ice therapy to reduce inflammation
- Anti-inflammatory medications when appropriate
- Physical therapy to improve strength, flexibility, posture, and shoulder mechanics
- Stretching and range-of-motion exercises
- Corticosteroid injections to reduce inflammation and pain
- Platelet-rich plasma (PRP) injections in selected cases
- Treatment of contributing rotator cuff conditions
- Ultrasound-guided procedures when indicated
When conservative treatment fails and structural abnormalities persist, surgical procedures such as arthroscopic decompression or treatment of associated rotator cuff pathology may be considered.
