Shoulder pain can be a real nuisance, it affects everything from reaching into cupboards to sleeping comfortably. One common culprit I see in the clinic is subacromial bursitis. This condition often crops up in people who use their arms a lot above shoulder height, think painters, swimmers, or even gym-goers who love overhead pressing (1). Let’s break down what it is, how a physiotherapist assesses it, and what treatment might look like.
What is Subacromial Bursitis?
The subacromial bursa is a small fluid-filled sac that sits just under the acromion (the bony roof of the shoulder). Its main job is to reduce friction between the rotator cuff tendons and the bones when we move our arm. When this bursa gets irritated or inflamed, it can lead to pain, swelling, and restricted movement (2).
Common symptoms include:
● A sharp or aching pain on the outer part of the shoulder.
● Pain when lifting your arm, especially overhead.
● Discomfort when lying on the affected side.
● A ‘pinching’ sensation during certain movements.
How Does a Physiotherapist Assess It?
Assessment is all about understanding the cause of your pain and ruling out other shoulder conditions that can mimic bursitis (like rotator cuff tendinopathy or impingement syndrome).
Here’s what a typical physio assessment might involve:
- Detailed History – When did the pain start? Was there an injury, or did it build up over time? What activities make it worse?
- Observation & Posture Check – We look for rounded shoulders, scapular winging, or muscle imbalances that might be contributing.
- Palpation – Pressing around the shoulder joint can sometimes pinpoint the tenderness directly over the bursa.
- Special Tests –
○ Neer’s Impingement Test: Lifting the arm while the scapula is stabilised – pain suggests a subacromial issue.
○ Hawkins-Kennedy Test: Bringing the arm into a ‘goalpost’ position and rotating it internally – often reproduces pain with bursitis (3).
○ Painful Arc Test: Pain between 60°–120° of arm movement is a classic sign. - Strength & Mobility Testing – Weakness in the rotator cuff or limited range of motion can highlight
contributing factors.
Physiotherapy Treatment for Subacromial Bursitis
The aim of treatment is to calm down the irritated bursa while also tackling the root cause, often muscle imbalances, poor posture, or repetitive overload (4).
Treatment may include:
● Activity Modification: Avoiding painful overhead movements or heavy lifting for a short period, but keeping the shoulder moving within comfortable limits.
● Manual Therapy: Soft tissue release, joint mobilisations, and gentle massage to improve movement and reduce muscle tension.
● Targeted Exercises:
○ Postural exercises – strengthening the muscles around the shoulder blade (like the lower trapezius and serratus anterior).
○ Rotator cuff strengthening – using resistance bands for external rotations and scapular stability.
○ Range of motion drills – pendulum exercises or wall slides to maintain flexibility.
● Taping or Strapping: To offload the shoulder and provide short-term pain relief.
● Modalities: Ice, shockwave therapy, or ultrasound may be used to reduce inflammation.
● Education: Teaching you how to avoid ‘pinching’ positions and how to modify exercises or daily tasks.
What About Injections?
For stubborn cases, a GP may recommend a corticosteroid injection into the bursa to settle inflammation. However, this works best when combined with a structured rehab plan rather than being a quick fix (5).
The Road to Recovery
Most cases of subacromial bursitis improve within a few weeks with the right guidance and exercise programme. The key is addressing the underlying cause – whether that’s posture, overtraining, or muscle weakness – to stop the problem coming back.
Our Barnet, Cockfosters & Enfield Physio’s have tons of experience and are specialists in treating all types of shoulder pain. Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.
Blog By: Emre Oz (Musculoskeletal Physiotherapist at Crouch Physio).
References
- Faruqi, Taha, and Tara J. Rizvi. “Subacromial Bursitis.” (2019)
- Kulkarni, Rohit, et al. “Subacromial shoulder pain.” Shoulder & elbow 7.2 (2015): 135-143.
- Hegedus, Eric J., et al. “Physical examination tests of the shoulder: a systematic review with
meta-analysis of individual tests.” British journal of sports medicine 42.2 (2008): 80-92. - Gebremariam, Lukas, et al. “Subacromial impingement syndrome—effectiveness of physiotherapy and
manual therapy.” British journal of sports medicine 48.16 (2014): 1202-1208. - Hsieh, Lin-Fen, et al. “Comparison of the corticosteroid injection and hyaluronate in the treatment of
chronic subacromial bursitis: A randomized controlled trial.” Clinical Rehabilitation 35.9 (2021):
1305-1316.
