Steroid Injections for Shoulder Bursitis

Shoulder Bursitis often occurs in combination with other conditions such as a rotator cuff tear or rotator cuff tendinopathy. “Shoulder Bursitis” refers to inflammation of a small sack of fluid that sits on top of the shoulder under the tip of the shoulder called the acromion. 

Symptoms of Shoulder Impingement

The most common symptoms of shoulder bursitis are:

• Pain as you raise your arm to the side (often this is in a specific range of motion that we call an “arc of impingement”).
• Pain reaching above your head
• Pain reaching into a jacket or reaching behind the back
• Pain lying on the side in bed which can wake you overnight

Shoulder Joint Anatomy

The shoulder is a ball and socket joint made up of the humerus (upper arm bone) and the scapular (shoulder blade). The socket on the scapula, know as the glenoid fossa, is not very big or deep which then requires additional support to prevent the shoulder becoming unstable. This anatomy however allows for a greater degree of motion that we utilise compared to other joints. The other main stabilising structures are the rotator cuff muscles. This is a group of 4 muscles (supraspinatus, subscapularis, infraspinatus and teres minor) that provide stability to keep the ball in the socket. When there is an imbalance of these muscles, the arm bone may move excessively in one direction which may in turn cause a shoulder injury. Bursitis may occur as a result of excessive elevation of the ball in the socket which causes a compression to the bursa. It may also occur as a result of a fall where the arm bone compresses the bursa.

Specific diagnosis

To work out if you have a bursitis in the shoulder we usually need to carry out a diagnostic ultrasound scan or MRI.

Bursitis

This refers to inflammation of the subacromial subdeltoid bursa which is a fluid filled sack sitting in a small space on top of the shoulder. If this bursa becomes inflamed and swells, then it gets pinched as you raise your arm. Once it pitches again, then its more likely to swell and the cycle of impingement continues.

Often a bursitis accompanies other injuries in the shoulder like rotator cuff injuries.

The most commonly affected rotator cuff injury is to a muscle called the supraspinatus. If the tendon is injured you may also get swelling in the subacromial bursa.

How to diagnose

One of our highly skilled Physiotherapists will ask a series of questions and perform a physical examination to help determine your diagnosis. Here at Oxford Circus physiotherapy we can also use diagnostic ultrasound to check the bursa and surrounding rotator cuff. Using the diagnostic ultrasound also allows the clinician to assess the shoulder joint dynamically throughout painful arm movements. If we require further clarification, then occasionally we need to order an MRI scan.

Treatment

In general, shoulder bursitis can be well managed with conservative Physiotherapy treatment and not require any aggressive intervention. 

Symptoms usually resolve within 1 year. However, if you want to get better faster then we can also:

• Prescribe a course of physiotherapy to restore range of movement, strength and function of the rotator cuff and scapular stabilising muscles to stop aggravating the bursa.
  
• You can try over the counter anti-inflammatories to reduce the inflammation in the bursa.
  
• Short period of rest from aggravating factors – particularly lying on that shoulder and overhead activities. It is important to avoid aggravating activities for at least 6 weeks as returning to certain activities too soon can cause further injury.
  

Physiotherapy may include:

• Independent exercise program to strengthen the stabilising muscles of the shoulder joint and surrounding muscles.
  
• Advice on appropriate load management and a gradual return to activity plan
  
• Manual techniques including soft  tissue release to provide relief and help restore full range of movement.
  

Ultrasound guided corticosteroid injection

Shoulder Bursitis Ultrasound-guided corticosteroid injection

If symptoms have not improved after 6 weeks of physiotherapy, or if the pain is affecting your sleep, stopping you from performing everyday activities such as getting dressed or is limiting you from performing your physiotherapy exercises you may want to consider an ultrasound guided steroid injection. Take a look at Alex’s story and how he overcame shoulder pain

Steroid injections use a small dose of corticosteroid (a strong anti-inflammatory drug) and are injected under ultrasound-guidance into the Bursa.  Current evidence found that injections performed under ultrasound guidance are more accurate and more effective at reducing pain and improving function than landmark guided injections (Daniels et al, 2018).

If you would like more information or would like to book an appointment, please contact us on 0207 636 5774 or email info@oxfordcircusphysio.co.uk.
References
Daniels, E.W., Cole, D., Jacobs, B. and Phillips, S.F., 2018. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Los Angeles, CA: SAGE Publications.

Other Shoulder Conditions:

• Acromioclavicular Joint Osteoarthritis
• Shoulder Impingement
• Frozen Shoulder (Adhesive Capsulitis)
• Acromioclavicular Joint sprain
• Rotator Cuff Tear and Tendinopathy
• Distal Clavicle Osteolysis
• Calcific Tendinopathy Of The Shoulder