Understanding Shoulder Bursitis: Expert Insights from Dr. Michael A. Del Core

Introduction

As a double fellowship-trained shoulder and upper extremity surgeon practicing at MD West ONE across Omaha, NE, and Iowa, I frequently evaluate patients with persistent shoulder pain. A common culprit? Shoulder bursitis—particularly subacromial bursitis—a condition best managed with a thoughtful, patient-specific approach. Let’s explore what shoulder bursitis entails, how to diagnose and treat it effectively, and when to consider surgical options—all through the lens of expert care.

What Is Shoulder Bursitis?

Shoulder bursitis refers to inflammation of bursae—tiny fluid-filled sacs—within the shoulder. The most frequently affected is the subacromial bursa, situated between the supraspinatus tendon and the acromion. When inflamed, it disrupts the normal gliding motion of tendons and causes pain, especially during overhead movements.

Causes & Types of Shoulder Bursitis

1. Overuse and Mechanical Impingement
   Repetitive overhead activity or anatomical variants—such as a curved or hooked acromion—can decrease the subacromial space, leading to irritation and bursitis.
2. Associated Conditions
   Bursitis often coexists with tendon disorders such as rotator cuff tendinitis or tears. The bursa may become inflamed secondarily.
3. Other Contributing Factors
   Systemic inflammatory conditions—like rheumatoid arthritis, gout, diabetes, or crystal deposition—can predispose to primary bursal inflammation.

Symptoms & Diagnosis

• Symptoms: Pain (especially when lifting the arm overhead), stiffness, swelling, tenderness, and reduced mobility or functional impact.
• Physical Findings: Painful arc between 70° and 120° of abduction is a clue; movement-induced discomfort is classic.
• Diagnostic Tools:
  • Physical exam
  • Imaging—X-rays to exclude bone issues; MRI or ultrasound to assess bursal fluid, acromion morphology, and associated cuff tears.

Non-Operative Treatment: The First Line

In most cases, shoulder bursitis responds well to conservative management:

1. Rest & Activity Modification
   Avoid aggravating activities; brief immobilization may help acute cases.
2. Ice & NSAIDs
   Ice packs and NSAIDs help control inflammation and pain.
3. Physical Therapy
   • Acute Phase: Pendulum (Codman) exercises and gentle assisted range-of-motion activities help prevent stiffness.
   • Rehabilitation Phase: Strengthen rotator cuff and scapular stabilizers, improve posture, and correct shoulder blade mechanics.
     Studies show significant pain reduction within 12 weeks for most patients undergoing PT.
4. Corticosteroid Injections
   Provide rapid relief, particularly when combined with PT—though repeated injections warrant caution due to potential tendon weakening.

Operative Intervention: When to Consider Surgery

Surgery is reserved for refractory or complicated cases:

• Persistent symptoms despite 6–12 weeks of PT and conservative care.
• Severe anatomical impingement or irreparable damage to surrounding structures.

Prognosis & Prevention

• Prognosis: Favorable. Most cases resolve fully with conservative care
• Risk Factors for Poor Outcomes: Older age, delayed treatment, and systemic inflammatory diseases.
• Prevention Strategies:
  • Use proper technique during overhead activities
  • Strength training and posture control
  • Gradual progression in workloads
  • Adequate breaks and recovery.

Why Patients Should Choose Dr. Michael A. Del Core

• Training: Dual fellowships in Hand (UT Southwestern) and Shoulder & Elbow (Cleveland Clinic).
• Local Presence: Multiple clinics across Omaha, Elkhorn, and Council Bluffs, providing accessible, integrated care.
• Patient-Centered Philosophy: Emphasis on listening, education, and tailoring treatment plans—from PT to cutting-edge surgical options.
• Collaborative Environment: Strong coordination between orthopedic and PT teams at MD West ONE ensures seamless, efficient care.