Subacromial bursitis occurs when a bursal sac in the shoulder area becomes inflamed. The bursa is a fluid-filled sac that allows smooth motion between the bony prominence over the outside of the shoulder and the firm tendon that passes over the bone. This inflammation may lead to weakening and later rupture of these tendons. The shoulder tendons include the rotator cuff and biceps tendons.

Subacromial bursitis can occur as a result of injury, overuse, or with aging as the tendon loses elasticity. Subacromial bursitis can also be seen in diseases such as rheumatoid arthritis or diabetes.

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Overuse is the most common cause of subacromial bursitis. People beginning an exercise program or increase their level of exercise can experience symptoms of subacromial bursitis. The area is unaccustomed to the new level of demand, and this overuse will cause an inflammation and bursitis.

Subacromial bursitis can be caused by a number of factors. Some of the more common factors associated with subacromial bursitis include:

• A sudden increase in the intensity of training. 

• A rapid increase in the frequency of training. 

• Repeated training on rigid surfaces.

• Poor core strength.

• Genetic abnormalities.

Symptoms of subacromial bursitis  include:

• Pain, tenderness and swelling along the tendon, usually in proximity to the shoulder joint.

• Pain that worsens with movement or activity.

• Shoulder pain at night, especially when lying on the affected shoulder.

• Stiffness after exercise involving the shoulder.

• Pain associated with arm movement.

• Weakness with raising the arm above the head, or pain with overhead activities.

The goal of subacromial bursitis treatment is to relieve pain and reduce inflammation. Often, rest, ice and home care pain relievers are all that's needed. The goals of subacromial bursitis treatment and shoulder bursitis rehabilitation include;

• Protection of the injured tissues to allow healing and to control the early inflammatory phase.

• Ice packs or ice massage.

• Rehabilitate flexibility, strength and muscle imbalance, and control physical activities with the aid of taping and splinting.

• Non-impact aerobic conditioning, flexibility training and strengthening exercises.

• Return to full activity as shoulder bursitis symptoms allow.

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The goal of rehabilitation should be designed to decrease the symptoms, strengthen the muscles and improve flexibility. The person with subacromial bursitis must return to sports activity carefully and slowly. Criteria for resuming full physical activity should be based on function, not time.

Inflammation can also be treated with nonsteroidal anti-inflammatory medications such as Motrin or Advil. These medications can be helpful treatments for subacromial bursitis but do have side effects. Side effects of these medications can include stomach upset and bleeding problems.

Your doctor might suggest treating your subacromial bursitis with steroid drug injections. Injections of cortisone reduce shoulder tendonitis inflammation and can help ease pain. However, this subacromial bursitis treatment should be used with great care because repeated injections may weaken the tendon or cause undesirable side effects.

Prevention is the best treatment for subacromial bursitis. The key to avoiding problems such as subacromial bursitis is to slowly increase the intensity of your exercise, vary the types of activities you perform, and try not to cycle between periods of activity and inactivity. Follow these guidelines to prevent subacromial bursitis or prevent the recurrence of subacromial bursitis:

• Do not train hard when muscles are stiff from a previous workout.

• Introduce new activities or new training levels gradually.

• Allow ample  warming up and cooling off time.

• Monitor yourself daily for signs of fatigue. If fatigued, give yourself a break for the day.

Proper conditioning should include aerobic fitness, upper body strength training, and upper body flexibility training. Flexibility is very important in preventing overuse injuries such as subacromial bursitis.

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