Shoulder Bursitis: Symptoms, Causes & PT Treatment
Updated October 20261 minute read
Shoulder bursitis is inflammation of the bursa — a small fluid-filled cushion under the top of the shoulder blade that reduces friction. It causes pain with reaching and overhead movement, often alongside rotator cuff irritation. It's usually not serious and responds well to physical therapy and load management. A hot, red, swollen shoulder with fever is different and needs urgent medical care.
What is shoulder bursitis?
The subacromial bursa cushions the rotator cuff tendons as they move. When it's irritated, it swells and becomes painful — frequently as part of the same overload picture as impingement and cuff tendinopathy.
Symptoms
Pain on the outer shoulder with reaching, lifting, and overhead movement, sometimes with night pain and tenderness. Motion may feel painful but is usually not locked.
What causes it / risk factors
Repetitive overhead activity, a sudden increase in load, and rotator cuff irritation are common triggers. Rarely, bursitis is caused by infection, which behaves very differently (hot, red, feverish).
How it's diagnosed
Diagnosis is clinical. Imaging is reserved for unclear or non-responding cases. Suspected infection requires urgent medical evaluation, not just PT.
Physical therapy treatment
What a PT does. Your therapist calms the irritation, restores pain-free movement, and strengthens the cuff and shoulder-blade muscles to reduce compression. Exercises & progression (overview). Activity modification early, then rotator cuff and scapular strengthening and graded return to overhead tasks. Recovery timeline. Many cases settle within several weeks of consistent work.
Treatment options compared
PT and load management are first-line. Short-term pain relief helps. Injections may be used for stubborn inflammation; surgery is rarely needed.
Red flags
A hot, red, swollen shoulder with fever needs urgent care for possible infection. Also seek care for arm pain with chest pressure (emergency) or sudden major weakness.
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Frequently asked questions
Many cases improve within a few weeks with the right exercises and load management.
Sources (5)
- NIH MedlinePlus: Bursitis. — NIH/MedlinePlus
- AAOS OrthoInfo: Shoulder Impingement/Rotator Cuff Tendinitis (includes subacromial bursitis). — AAOS OrthoInfo
- Beard DJ, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a placebo-controlled, three-group, randomised surgical trial. Lancet. 2018. — The Lancet
- Lähdeoja T, et al. Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis. Br J Sports Med. 2020. — BJSM
- Steuri R, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med. 2017. — BJSM
This article is for education only and isn't medical advice. Always talk to a licensed clinician about your specific situation.