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Shoulder Bursitis is an inflammation of a bursa and is usually characterized by pain and sometimes by redness and swelling. A bursa is a very thin sac-like structure that is located wherever there might be friction, such as between skin and bones, between tendons and bones or between ligaments and bones int the shoulder. In other words, they serve to decrease the friction that occurs between hard bone and softer tissues. Skin, tendons, and ligaments would wear out if there were no bursa between them and bony surfaces. As a result, there are over 150 bursae in the body, wherever there is the possibility of rubbing.

A bursa is normally very thin and does its job without notice. However, if there is too much friction, it reacts by getting inflamed or irritated. When this happens, the bursa gets thicker and sometimes produces fluid to create more cushion. It goes from being very thin (like tissue paper) to thick and lumpy (like corrugated cardboard). The bursa can be very large if a lot of fluid is produced inside. Sometimes it can be colonized by bacteria, and in this case, becomes an infected bursa. It can be difficult to distinguish an inflamed bursa (irritated with no infection) and an infected bursa (irritated with infection or bacteria present). 

Bursitis of the shoulder causes pain and discomfort and can often affect day to day life. Steroid injections have been found to be an effective way of alleviating pain and helping the shoulder to move freely without pain. These injections utilise corticosteroids and anaesthetic to target the pain and manage the condition.  

What causes Shoulder bursitis? 

The condition is usually caused by too much stress on the bursa. Bursal irritation can be roughly divided into three groups. 

Chronic bursitis, this type is the most common and develops over time due to repetitive irritation of the bursa. Most people who get this type have no predisposing problems, and the inflammation occurs for no apparent reason. It occasionally can occur in people who have a pre-existing medical condition that causes the bursa to swell.

Infected bursitis, this type is more serious. In this type, the bursa becomes infected with bacteria. If the infection spreads, it can cause serious problems.

Traumatic bursitis (or acute traumatic bursitis), this type is typically seen in athletes. Of the three types, it is the least common. It is due either to repetitive rubbing of an extremity against a hard surface or from too much bending of the joint. 

What are the symptoms of bursitis? 

The symptoms of shoulder bursitis depend on the severity of the inflammation and the type of bursitis present. In chronic shoulder bursitis, swelling is the most obvious symptom. Patients with this type often seek medical attention because they notice swelling that has gone on for some time and does not improve. It is rarely painful and usually not reddened. However, this type of bursal swelling can get warm and painful without being infected.

In infected shoulder bursitis patients usually experience excessive warmth at the site of the inflamed bursa in the shoulder. They often complain of a great deal of tenderness, pain, and fever. The swelling and redness may spread away from the affected site and go up or down the arm. Also, an infected bursa can make you feel very sick, feverish and tired. If you have any of these symptoms, it is very important to seek immediate medical attention.

Traumatic shoulder bursitis presents with the rapid onset of swelling. These cases usually occur after a specific event, such as trauma like an impact on a hard surface or a collision. The swelling may also be accompanied by bruising. 

Steroid injections for shoulder bursitis 

You should discuss your symptoms and their impact on your life with your healthcare provider to decide which next steps are the best. Chronic shoulder bursitis is the most common form of shoulder bursitis and is often treated with steroid injections. If you have another form of bursitis your healthcare provider will advise accordingly. 

As chronic bursitis stems from the swelling of the bursa, targeting this swelling and inflammation is the key to help ease the symptoms and their effects. Steroid injections are effective in alleviating specific pain present in joints and muscles of the steroid, whether the pain is from arthritis or from injury. After an injection, patients often feel immediate relief from the pain and effects can last for several months. Depending on the area being treated, steroid injections can be administered in the same place up to four times in a year.  

Steroids (specifically Glucocorticoids) are very powerful anti-inflammatory substances. They can settle down a painful joint or other soft tissue and give patients the opportunity to get on with their everyday activities. The injection also administers local anaesthetic to provide some immediate relief until the steroid has time to take effect. The steroids used at Fusion Healthcare are not the same as those used to build muscle. Medications are administered very cautiously and Fusion Healthcare we will not recommend patients to have large numbers of repeated injections. 

What is involved in the process? 

An ultrasound transducer, otherwise known as an ultrasound probe, is used to acquire the images of the affected shoulder or shoulders. The probe is applied to the area that is being scanned and a water-based gel is used to allow for good contact and less friction between the prob and the skin. The probe is used to identify the where the pain is coming from and pinpoint the best place for the insertion of the needle and administration of the local anaesthetic and steroid. As such, a thorough ultrasound investigation of the area is important before proceeding as well as discussing with the patient where they feel the most pain when doing their everyday tasks. 

The procedure is carried out by a highly qualified NHS clinician in the Fusion Healthcare clinic, who will thoroughly discuss with the patient the ins and outs of the procedure and follow up care. 

As this is a procedure involving the administration of medication, a referral is required from a healthcare provider before having the procedure done privately. Often, physios may refer their patients for this form of treatment if physiotherapy alone is providing little relief from the pain. Additionally, chronic pain that may not be alleviated by painkillers can also warrant this form of treatment. Discuss options with your healthcare provider. 

It is very important to inform your doctor of any health condition you have which affects the way your blood clots, such as haemophilia.  As a shoulder injection can raise your blood sugar levels for several days, it is also important to inform your consultant if you have diabetes as you will likely need to adjust your medication.