Shoulder Bursitis Treatment
Shoulder bursitis — most commonly subacromial bursitis — occurs when the bursa, a thin, fluid-filled sac that cushions the space between the rotator cuff tendons and the acromion bone above them, becomes inflamed and swollen. The subacromial bursa normally allows the rotator cuff tendons to glide smoothly beneath the acromion during shoulder movement. When the bursa becomes irritated — from repetitive overhead activity, a direct injury, bone spurs, or underlying shoulder impingement — it swells and thickens, reducing the already limited space in the subacromial region and producing pain with nearly every overhead movement. Shoulder bursitis is one of the most common causes of shoulder pain and frequently coexists with rotator cuff tendinitis, impingement syndrome, and rotator cuff tears — which is why accurate diagnosis of the underlying cause, not just the bursitis itself, is essential for effective long-term treatment.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with a traveling shoulder fellowship under Dr. Charles Rockwood and Dr. Richard Hawkins and fellowship training in arthroscopic surgery at the Southern California Orthopedic Institute/UCLA. Shoulder bursitis is rarely an isolated condition — in most cases, it is a symptom of an underlying mechanical problem in the subacromial space, and treating the bursitis without identifying and addressing the root cause leads to recurrence. Dr. Glashow’s approach focuses on diagnosing why the bursa became inflamed — whether from impingement, bone spurs, rotator cuff disease, or another structural issue — and treating the source, not just the symptom. With over 30 years of experience, more than 15,000 procedures, and recognition as a Castle Connolly Top Doctor every year since 2000, he evaluates and treats shoulder bursitis at his Upper East Side practice in New York City.
Causes and Risk Factors
Shoulder bursitis most commonly develops as a result of subacromial impingement — a condition in which the rotator cuff tendons and bursa are compressed beneath the acromion during overhead movements. The impingement irritates the bursa and causes it to swell, which further narrows the subacromial space and worsens the compression — creating a self-perpetuating cycle of inflammation and pain.
Other causes and contributing factors include repetitive overhead activity (painting, swimming, throwing, tennis), bone spurs on the underside of the acromion that reduce the available space, rotator cuff tendinitis or partial rotator cuff tears, direct trauma or a fall onto the shoulder, inflammatory conditions such as rheumatoid arthritis or gout, infection (septic bursitis — rare but requires urgent treatment), and systemic conditions including diabetes and thyroid disease.
Symptoms of Shoulder Bursitis
- Pain on the outside and top of the shoulder, often radiating down the upper arm
- Pain that worsens with overhead reaching, lifting, and lying on the affected side
- Shoulder stiffness, particularly in the morning or after periods of inactivity
- Swelling and warmth over the top of the shoulder
- Tenderness when pressing on the outside of the shoulder
- A painful arc of motion — pain that occurs when raising the arm between approximately 60 and 120 degrees
- Difficulty sleeping on the affected side
Treatment Options
The majority of shoulder bursitis cases respond well to non-surgical treatment, particularly when the underlying cause is identified and addressed.
Conservative Treatment: Rest and activity modification — avoiding the overhead movements that aggravate the bursa — combined with anti-inflammatory medications and ice can provide initial relief. Physical therapy focused on rotator cuff strengthening, scapular stabilization, and postural correction addresses the mechanical factors that contribute to impingement and reduces the load on the bursa. Corticosteroid injections into the subacromial space can provide significant relief by directly reducing the bursal inflammation, and are particularly useful for patients whose pain is too severe to participate in physical therapy.
Arthroscopic Subacromial Decompression: When conservative treatment has not provided adequate relief after several months — or when imaging reveals bone spurs, a thickened acromion, or an associated rotator cuff tear that requires surgical attention — Dr. Glashow may recommend arthroscopic surgery. The procedure involves removing the inflamed bursal tissue (bursectomy), shaving the underside of the acromion to increase the subacromial space (acromioplasty), removing any bone spurs, and repairing associated rotator cuff damage if present. The procedure is performed on an outpatient basis through small keyhole incisions.
Shoulder Bursitis Treatment in New York City
If you are experiencing shoulder pain that worsens with overhead activity, interferes with sleep, or has not responded to rest and anti-inflammatory medications, the cause may be subacromial bursitis — and identifying the underlying mechanical problem is the key to lasting relief. Dr. Glashow offers comprehensive shoulder evaluation with same-day imaging at his Upper East Side practice. Contact our office to schedule your consultation.
Frequently Asked Questions About Shoulder Bursitis
What is shoulder bursitis?
Shoulder bursitis is inflammation of the subacromial bursa — a thin, fluid-filled sac that sits between the rotator cuff tendons and the acromion bone at the top of the shoulder. The bursa normally provides a smooth, friction-free surface that allows the rotator cuff to glide beneath the acromion during arm movement. When the bursa becomes inflamed, it swells and thickens, reducing the available space in the subacromial region and producing pain with overhead activity, reaching, and lying on the affected shoulder.
What is the difference between bursitis and impingement?
Bursitis and impingement are closely related and often coexist. Impingement refers to the mechanical compression of the rotator cuff tendons and bursa beneath the acromion during overhead movement — it describes the structural problem. Bursitis is the inflammatory response of the bursa to that compression — it describes the resulting tissue inflammation. In most cases, treating the impingement (the cause) resolves the bursitis (the effect). This is why Dr. Glashow evaluates the subacromial space, acromion shape, and rotator cuff integrity as part of every bursitis workup.
How is shoulder bursitis diagnosed?
Dr. Glashow diagnoses shoulder bursitis through a clinical examination that assesses pain location, range of motion, rotator cuff strength, and the specific movements that reproduce the symptoms. The impingement signs — pain during specific provocative maneuvers that compress the subacromial space — are typically positive. X-rays can reveal bone spurs, acromion shape, and other bony abnormalities. An MRI may be ordered to evaluate the bursa directly, assess the rotator cuff for tears or tendinitis, and rule out other causes of shoulder pain. Same-day imaging is available at his Upper East Side practice.
Can shoulder bursitis heal on its own?
Mild bursitis caused by a single episode of overuse or minor irritation can sometimes resolve on its own with rest and avoidance of aggravating activities. However, bursitis caused by an underlying structural problem — such as impingement from bone spurs, a thickened acromion, or rotator cuff disease — typically does not resolve permanently without addressing the root cause. The inflammation may temporarily improve with rest but returns as soon as overhead activity resumes. This is why Dr. Glashow focuses on identifying and treating the underlying mechanical problem rather than just managing the bursitis symptoms.
How effective are cortisone injections for shoulder bursitis?
Corticosteroid injections into the subacromial space are highly effective for reducing bursal inflammation and pain — most patients experience significant relief within a few days. However, injections treat the symptom (inflammation) rather than the cause (impingement or rotator cuff disease), so they are most effective when combined with physical therapy that addresses the underlying mechanical factors. Repeated cortisone injections over time can weaken tendon tissue, so Dr. Glashow typically limits the number of injections and uses them strategically — often to reduce pain enough for the patient to participate effectively in their rehabilitation program.
When is surgery needed for shoulder bursitis?
Surgery is considered when shoulder bursitis has not responded to an adequate course of conservative treatment — typically three to six months of physical therapy, activity modification, and at least one corticosteroid injection — and the patient continues to experience significant pain and functional limitation. Arthroscopic subacromial decompression removes the inflamed bursa, shaves bone spurs from the acromion, and increases the space available for the rotator cuff tendons — addressing both the bursitis and the impingement that caused it. The procedure is minimally invasive, performed on an outpatient basis, and produces reliable long-term results.
