What is sub-acromial bursitis?

Inflammation of the biggest bursa in the shoulder, positioned between the ball and socket, is known as sub-acromial bursitis. It causes excruciating agony that is exacerbated by any shoulder movement, especially moving your arm out to the side and above your head. It affects people of all ages, and it is prevalent in both active and sedentary persons. It frequently develops in conjunction with rotator cuff problems. Ultrasound is used to identify subacromial bursitis, and it will be done at your initial appointment. Rest, medications, and a course of physiotherapy are usually effective treatments for subacromial bursitis. If it doesn’t get better and is keeping you up at night, an ultrasound-guided steroid injection is a good alternative.

Your Care Pathway with us

  • To book an appointment you can call on, 020 8870 8761, email direct to 
  • Complete MSK Examination and testing.
  • Discussion of your treatment plan; Treatment Plans can include Ultrasound Guided Cortisone Injection and Ostenil plus (Hyaluronic injection) 

What are the symptoms of sub-acromial bursitis?

The symptoms of a sub–acromial bursitis are:

  • When you move your arm out to the side and above your head, the pain gets worse.
  • Pain is worse at night, and it frequently leads you to wake up in the middle of the night.
  • Lying on your side causes pain.

What conditions can be mistaken for biceps tendinitis?

If this does not sound like your discomfort, there are a number of different disorders that can cause pain similar to subacromial bursitis, including:

  1. Frozen shoulder
  2. Shoulder impingement
  3. Rotator cuff pain.
  4. Calcific tendinopathy

Sub-acromial bursitis vs frozen shoulder

Both subacromial bursitis and frozen shoulder produce substantial pain and weakness in the shoulder, especially at night, and frequently result in sleepless nights. Frozen shoulder, on the other hand, is coupled with severe stiffness in addition to the pain. This is the main distinction between the two situations.


A bursa is a tiny sac of soft tissue that is filled with fluid. They can be found in the spaces between tendons and muscles, tendons and other tendons, and tendons and bones. They’re made to act as a cushion, shielding the buildings around them from damage during movement or direct impact. A bursa’s protective function helps to decrease irritation and inflammation produced by excessive stress imposed on adjacent structures. Bursas, however, can become injured and inflamed, and when they do, they are extremely painful.

What is shoulder bursitis?

The most prevalent cause of shoulder impingement syndrome is shoulder bursitis (Wu et al., 2015). Direct trauma or a sudden increase in activity, such as beginning a new sort of exercise or sport, can trigger it. Bursitis can potentially develop into a chronic condition (pain that has been present for over 3 months). A bursa might thicken as a result of constant discomfort. This thickening might irritate the bursa even more during movement, creating a painful cycle.

The sub acromial bursa of the shoulder (the subject of this blog) is the most common source of pain for a variety of shoulder disorders, according to research. 

The sub acromial bursa of the shoulder is located between the supraspinatus tendon (a key rotator cuff muscle) and the acromion (the bone at the corner of the collar bone and the shoulder blade). This bursa thickens and swells as a result of repeated misuse or injury (known as bursitis). The bursa can be squeezed under the acromion if this happens (known as an impingement).

The following conditions are frequently related with the presence of shoulder bursitis. Draghi et al., (2015) observed the occurrence rates of bursitis in the following conditions:

Rheumatoid arthritis and infection are two further reasons of shoulder bursitis that are not mentioned in this blog.

Different illnesses necessitate very different management strategies, therefore determining the underlying cause of the inflamed bursa is critical to effectively treating shoulder bursitis.

What are the symptoms of shoulder bursitis?

Symptoms of shoulder bursitis are similar to those of a variety of shoulder problems (for which bursitis is frequently present, as previously mentioned), but they include:

  • Pain that radiates from the shoulder down the arm and into the elbow.
  • Sharp pain, especially when raising the arm.
  • Due to pain, the arm’s range of motion is limited.
  • Pain causes a feeling of weakness in the arm.
  • Sleeping on the affected side is impossible.
  • Pain in the night.
  • Due to pain, many people wake up frequently during the night.

How is shoulder bursitis diagnosed?

Because there are so many causes of shoulder bursitis, it’s critical to get a quick and correct diagnosis in order to get the best therapy. If you think you could have shoulder bursitis, you should get expert care right once. 

An orthopaedic doctor or a physiotherapist can perform a shoulder examination, which consists of a series of questions meant to discover any underlying causes of your symptoms. Following the interview, the clinician will undertake a clinical evaluation. Asking you to move your arm, assessing your strength, and palpating different structures around your shoulder are all part of the clinical evaluation. This procedure tells the clinician if your pain is coming from your shoulder, but diagnostic imaging is required to confirm a diagnosis of shoulder bursitis.

Sub-acromial bursitis

Diagnostic ultrasound imaging

The European Society of Radiology (2018) found that diagnostic ultrasonic imaging is just as effective as MRI in detecting shoulder bursitis and rotator tendon injuries. Our professionals at Joint Injections are fully qualified physiotherapists and musculoskeletal sonographers with extensive expertise evaluating shoulder discomfort. A clinical examination and a formal diagnosis using ultrasound imaging are part of the Joint Injections evaluation.

How do we treat shoulder bursitis?

The treatment for shoulder bursitis varies depending on the underlying reason; however, many people find that a combination of over-the-counter painkillers, physiotherapy, and a home exercise regimen, all under the supervision of a physiotherapist, works well for them.

Here are a few ideas to get you started:

  • Don’t make your shoulder ache worse. Irritating your shoulder on a regular basis will prevent it from “healing” and may even make things worse.
  • Before going to bed, try stretching. This may help to reduce inflammation in the area, allowing you to have a better night’s sleep.
  • Consider applying ice to your shoulder. Frozen peas wrapped in a tea towel and placed over the uncomfortable spot for 10 minutes should help.
  • Sleeping on the sore side is not a good idea. Sleep on your back or the other side if possible.
  • Throughout the day, try to keep your body in a neutral position. Your shoulder will be irritated considerably more if you have poor posture at work.
  • Try a brief course of over-the-counter pain relievers, but always check with your pharmacist or doctor before taking any medicine.
Shoulder-Bursitis treatment in UK

What if therapeutic approaches don’t work?

If you’ve tried physiotherapy and a regular home exercise regimen but your pain persists, is interfering with your ability to work or play sports, or is waking you up at night, an injection may be necessary.

Our specialists at Joint Injections are completely qualified to administer ultrasound-guided steroid injections. This cutting-edge, evidence-based approach employs an ultrasound equipment to monitor the needle’s passage into the target structure in real time (in this case the sub acromial bursa). For shoulder bursitis, ultrasound guided steroid injections have been found to be much more accurate and safe than landmarked injections (Wu et al., 2015). Many patients also claim that this method is more pleasant and produces quicker results.

What are the effects of steroid injections on inflamed bursae?

Corticosteroid (also known as steroid) is a powerful anti-inflammatory medicine that is injected directly into the bursa. The findings have a quick effect, lowering bursa discomfort, irritation, and inflammation dramatically. The goal is for you to be able to repair your shoulder as a result of this.

Muscle weakness is almost always the result of a bout of shoulder pain. As a result, following any injectable treatment, we strongly advise a physiotherapy programme. Physiotherapy can help restore complete strength and flexibility to the shoulder, lowering the chance of recurrence.

Are injections for shoulder bursa painful?

Injections into the shoulder bursa are generally painless and are administered with a very small needle. They’re well tolerated, with many patients reporting that they don’t even notice the needle! Although a tiny number of people will suffer an increase in pain for a few days after the injection, it is possible.

Do shoulder bursa injections hurt after the injection?

A local anaesthetic is coupled with a steroid injection. The local anaesthetic will assist to alleviate any acute pain from the injection, which is usually minor.