Physical Therapy Guide to Shoulder Bursitis
Shoulder bursitis is a condition that causes pain on the outer side or tip of the shoulder. It can affect people of any age. Most commonly, it results from overuse and develops gradually in people who often throw, pitch, or swim. Non-athletes can develop the condition through repetitive movements such as overhead lifting or reaching. An injury, infection, or other problems, such as an autoimmune disease, also can cause bursitis. Physical therapy can be a very effective treatment for shoulder bursitis. Physical therapists help reduce pain, swelling, and stiffness caused by the condition. They also address related weakness in the shoulder, arm, neck, and upper back.
Shoulder impingement and tendinitis can occur along with shoulder bursitis. These three conditions (which researchers often label "subacromial shoulder pain") share many similar symptoms. A physical therapist can effectively treat all of these conditions.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is Shoulder Bursitis?
Shoulder bursitis occurs when the bursa becomes damaged, irritated, or inflamed. The bursa is a fluid-filled sac on the side of the shoulder that cushions the rotator cuff tendon. It prevents the tendon from rubbing on the bone above it. "Itis" means inflammation. Certain positions, motions, or diseases can cause friction or stress on the bursa. When the bursa becomes injured, and the tendon does not glide smoothly, bursitis and pain can result.
Shoulder bursitis can be caused by:
- Repetitive motions (overhead reaching or lifting, throwing, or twisting of the arm).
- Muscle weakness or poor muscle coordination.
- Incorrect posture.
- Direct trauma (being hit, or falling on, the side of the shoulder).
- Shoulder surgery or replacement.
- Calcium deposits in the shoulder.
- Overgrowth or bone spurs in the acromion bone.
- Autoimmune diseases, such as rheumatoid arthritis, gout, psoriasis, or thyroid disease.
- Muscles or tendons in the shoulder that rub the bursa and cause irritation.
How Does It Feel?
With shoulder bursitis, you may experience pain:
- On the outer side or tip of the shoulder.
- When you push with your finger on the tip of the shoulder.
- When lying on the affected shoulder.
- That worsens when lifting the arm to the side.
- When rotating the arm.
- When pushing or pulling open a door.
How Is It Diagnosed?
A physical therapist will conduct a full evaluation, including taking your health history. They also will ask you detailed questions about your condition, such as:
- How and when did you notice the pain?
- Have you been doing any repetitive activity?
- Did you receive a direct hit to the shoulder or fall on it?
Your physical therapist may perform special tests to help determine if you have shoulder bursitis. They will gently press on the outer side of the shoulder to see if it is painful to the touch. They may conduct additional tests to determine if other parts of your shoulder are injured. They also will observe your posture and how you lift your arm.
Your physical therapist will test and screen for other, more serious conditions that could cause shoulder pain. They may recommend further tests to confirm the diagnosis and rule out other conditions or a fracture. They also may team with an orthopedic doctor.
How Can a Physical Therapist Help?
Your physical therapist will work with you to design a specific treatment program to speed your recovery. This program will include exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies. Results can often be achieved in two to eight weeks when following a proper stretching and strengthening program.
During the first 24 to 48 hours after your diagnosis, your physical therapist may advise you to:
- Rest the area. This will include avoiding lifting or reaching overhead or any activity that causes pain.
- Apply ice packs to the area for 15 to 20 minutes every two hours.
- Consult with a doctor for further services or diagnostic tests.
Your physical therapist will customize a treatment program to help you safely return to your desired activities. Your physical therapy program may include:
Patient education. Your physical therapist will help you understand your diagnosis. They will identify any external factors causing your pain and recommend changes to your exercise routine. They also will suggest ways to improve how you perform athletic and everyday activities. Your physical therapist will teach you safe exercises to help ensure a pain-free return to your activities.
Pain management. Your physical therapist will help you improve your shoulder pain by addressing inflammation, limited range of motion, and other factors. They may provide treatments such as icing the affected area and teaching you how to modify activities that cause pain. Physical therapists are experts in pain-management techniques that reduce or eliminate the need for medication, including opioids.
Range-of-motion exercise. Shoulder bursitis can limit your shoulder and arm mobility and lead to increased stress on your shoulder. Your physical therapist can teach you self-stretching techniques to help decrease tension and help restore normal shoulder movement.
Manual therapy. Your physical therapist may use hands-on treatments (manual therapy) to gently move your shoulder muscles and joints. These methods help improve how your shoulder moves. Your physical therapist also may provide gentle resistance to improve strength in the shoulder area.
Muscle strengthening. Muscle weaknesses or imbalances can contribute to shoulder bursitis. Your physical therapist will design a safe, progressive resistance program to improve the strength of the muscles that support your shoulder. They will select the right exercises for you based on your symptoms, age, and condition. They may have you use a hand cycle to help build muscle endurance. Your physical therapist also may teach you exercises to strengthen your core muscles to support and improve your overall movement.
Functional training. Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. Learning safe, controlled movements to minimize stress on your shoulder and arm is important. Your physical therapist will create a series of activities to help you learn how to move your body correctly and safely.
If Surgery Is Needed
Surgery is not commonly needed for shoulder bursitis. If you have surgery, you will follow a physical therapy recovery program over several weeks. After surgery, your physical therapist will address your pain. At the right time, they will help you regain movement and strength through the methods described above. Your physical therapist will help you return to normal activities in the safest, fastest way possible.
Can This Injury or Condition Be Prevented?
Some causes of shoulder bursitis, such as traumatic injury or autoimmune disease, cannot be prevented. You can reduce your risk and the stress on your shoulder by addressing postural problems and ensuring you properly warm up before demanding repetitive work or sports activities.
Following the home exercise program, your physical therapist can help to prevent a return of shoulder bursitis. The exercises will help you strengthen and stretch your:
- Neck muscles.
Your physical therapist may advise you to:
- Be consistent in following a flexibility and strengthening exercise program, especially for your shoulder muscles. This will help you maintain good physical conditioning, even in a sport's off-season or after you retire from sports.
- Always warm up your shoulder muscles before starting a sport or heavy physical activity.
- Increase demanding activities for home, work, or sports gradually rather than suddenly.
- Learn and maintain correct posture.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat shoulder bursitis. However, you may want to consider:
- A physical therapist who is experienced in treating people with musculoskeletal injuries. Some physical therapists have a practice with an orthopedic or sports focus.
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists in your area with these credentials and clinical expertise on Find a PT, a tool built by the American Physical Therapy Association.
General tips when you are looking for a physical therapist (or other health care provider):
- Ask family, friends, and other health care providers to recommend a physical therapist.
- Ask about the physical therapist's experience treating shoulder bursitis before you make an appointment.
- Be prepared to describe your symptoms in as much detail as possible on your first visit, including what makes your symptoms better or worse.
The American Physical Therapy Association believes that consumers should have access to information to:
- Inform their health care decisions.
- Prepare them for their visit with a health care provider.
The following resources offer some of the best scientific evidence related to physical therapy treatment for shoulder bursitis. They report recent research and provide information on the standards of practice in the United States and internationally. They link to a PubMed* abstract (which may offer free access to the full text) or other resources. You can read them to learn more or bring a copy to your health care provider.
Mulcahy JA. Physical Therapy Guide to Shoulder Impingement Syndrome. APTA Choose PT. Revised January 4, 2021. Article.
Lanham NS, Swindell HW, Levine WN. The subacromial bursa: current concepts review. JBJS Rev. 2021 Nov 10;9(11). Article Summary on PubMed.
Pieters L, Lewis J, Kuppens K, et al. An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. J Orthop Sports Phys Ther. 2020;50(3):131–141. Article Summary on PubMed.
Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. J Hand Ther. 2004;17(2):152–164. Article Summary on PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.