Shoulder bursitis (subacromial bursitis) is irritation of the thin fluid sac, the bursa, that sits between the rotator cuff tendons and the bony tip of the shoulder. It usually causes pain on the outer upper arm, pain lifting the arm out to the side, and pain lying on that shoulder. Treatment is mostly cutting back what provokes it, then graded exercise. Many people improve over 6 to 12 weeks. Some take 3 to 6 months.
The bursa lets the tendons glide under the bone. When the tendons beneath it are overloaded, the bursa often becomes irritated and thickened too. That is why bursitis and rotator cuff tendinopathy so often appear together, and why the treatment for both looks similar.
Less often, a bursa becomes infected, or inflamed as part of a condition such as rheumatoid arthritis or gout. Those cases behave differently: the shoulder is often hot, swollen and very painful, sometimes with fever. They need a doctor, not an exercise plan.
Key takeaways
- What it is: irritation of the fluid sac between the rotator cuff tendons and the bony tip of the shoulder.
- Typical symptoms: outer upper arm pain, pain lifting the arm out to the side, and pain lying on that side.
- Common partner: it often occurs with rotator cuff tendinopathy, and the two are treated in a similar way.
- Main treatment: reduce the provoking movements, then build strength gradually. An injection is sometimes used to ease pain enough to exercise.
- Typical timeline: 6 to 12 weeks for many people; 3 to 6 months for some.
- Different picture: a hot, red, swollen shoulder or fever needs a doctor the same day.
Where are you right now?
- It has just started: read the week-by-week section. Reducing overhead work and sleeping on the other side are usually the first changes.
- Weeks in and not settling: go to “If it isn’t going to plan” and “Where else this could be coming from”.
- After an injection: pain often eases within a few days to two weeks. The weeks after are usually used to build strength gradually.
- Getting back to work or sport: the “When can I…” table gives typical ranges.
Week by week
- Weeks 0 to 2: pain is often at its most irritable, with night pain common. Cut back on reaching overhead and lifting with the arm out from the body. Keep the shoulder moving gently below shoulder height.
- Weeks 2 to 6: light strengthening with the elbow by your side, such as turning the arm outward against light resistance, plus work for the shoulder blade muscles. Night pain often starts to ease.
- Weeks 6 to 12: exercises move toward shoulder height and above. Many people find dressing, reaching and sleeping are much easier by now.
- Months 3 to 6: for slower cases, steady progress continues. Heavier, faster and overhead work is reintroduced last.
Where else this could be coming from
- Rotator cuff tendinopathy: the tendon under the bursa. The symptoms overlap so closely that the two are often treated as one problem.
- Rotator cuff tear: clear weakness lifting or turning the arm, especially after a fall or heavy lift.
- Calcific tendinitis: a calcium deposit can irritate the bursa above it and cause sudden, very severe pain.
- AC joint pain: pain on top of the shoulder, at the end of the collarbone, often worse reaching across your body.
- Frozen shoulder: stiffness in every direction that does not go away when someone else lifts your arm for you.
- The neck: pain that starts in the neck, spreads past the elbow, or comes with tingling.
Is this normal?
- “It hurts most when I lie on it.” Very common. Lying on that side presses on the bursa. Sleeping on your back or the other side, with a pillow to rest the sore arm on, usually helps.
- “My scan says bursitis and tendinopathy.” That combination is common and does not mean two separate problems to treat.
- “The injection helped, then it came back.” An injection usually calms pain for weeks to a few months. Without strengthening during that time, pain often returns when load goes back up.
- “There is no swelling I can see.” Normal. This bursa lies deep under the shoulder muscle, so it rarely shows from outside.
Calming the bursa buys time. Strengthening the tendons beneath it is what keeps it calm.
If it isn’t going to plan
Maybe it is week six and you are still sleeping propped on one side, rearranging the pillow at 3 a.m. You have kept the arm still, and the thought is that it should have settled by now. Keeping the arm still eases the bursa for a while. Meanwhile the rotator cuff and shoulder blade muscles weaken, the ball of the shoulder is less well controlled, and the bursa gets irritated again the moment you lift.
What this usually needs is two things in order: enough calm to sleep and move, then strength built in small steps so the tendons under the bursa can handle daily load. If you have not seen clear change after 6 to 8 weeks, or pain is getting worse, get assessed by a physical therapist or doctor. Useful questions to ask:
- Diagnosis: is this bursitis, tendinopathy, a tear or a mix?
- Program: what should I be doing now, and when should I progress it?
- Injection: would an injection help me get the exercise done, and how many are usually advised?
- Other causes: is there anything in my health history, such as arthritis or gout, that changes the picture?
When can I…
| Activity | Typical range |
|---|---|
| Sleep on that side | Often uncomfortable for 4 to 12 weeks |
| Drive | Usually possible throughout, if you can steer and check over your shoulder comfortably |
| Reach overhead | Occasional reaching early; repeated overhead tasks built up over 6 to 12 weeks |
| Lift | Light loads held close to the body early; heavier loads over 6 to 12 weeks |
| Desk work | Usually possible throughout, with the arm supported and the mouse close |
| Manual work or sport | Overhead, throwing or swimming often 2 to 4 months, built up gradually |
If you have had surgery, your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Chest symptoms: shoulder pain comes with chest pain or tightness, breathlessness, sweating or nausea, particularly on the left.
- Very unwell: a hot, swollen shoulder comes with high fever, shivering, or feeling confused or very unwell.
See a doctor today if
- Hot or red shoulder: the shoulder is warm, red or visibly swollen, with or without fever.
- Recent injection or wound: pain and redness increase in the days after an injection, or near a cut or graze on the shoulder.
- Higher infection risk: you have diabetes, take medicine that lowers immunity, or have a joint replacement, and the shoulder suddenly becomes very painful.
Get it checked soon if
- Weakness: you cannot lift the arm out to the side, or it drops as you lower it.
- No change: pain is no better after 6 to 8 weeks of reduced load and exercise.
- Other joints: other joints are also swollen or painful.
More on this area: shoulder conditions.
The sac is where it hurts. The tendons underneath are usually where recovery happens.
Written by Louise Yow, Neck & Shoulder Physio.