- SPECIALIST ORTHOPAEDIC SURGEON | MELBOURNE, VIC | ALBURY, NSW | MORNINGTON, VIC |
- 03 9421 6133
- Melbourne & Mornington VIC |
- Albury, NSW
Shoulder impingement or bursitis
Irritation and inflammation of the shoulder tendons or bursa causing pain with lifting or overhead movement
Shoulder impingement and subacromial bursitis are common sources of pain, particularly when lifting the arm or performing overhead movements. These conditions often occur together and can lead to inflammation, discomfort, and reduced shoulder function. Shoulder impingement refers to the pinching of soft tissues, such as the rotator cuff tendons or bursa, between the upper arm bone (humerus) and the bony arch of the shoulder (acromion). Over time, this repeated compression may lead to bursitis, which is inflammation of the small fluid-filled sac (bursa) that helps cushion and reduce friction in the joint.
These conditions may develop gradually through overuse, poor posture, or repetitive overhead activity. They can also occur following an injury or in association with other shoulder problems such as rotator cuff tears. With early diagnosis and treatment, most cases of shoulder impingement and bursitis can be managed successfully without surgery.
What is shoulder impingement or bursitis?
Shoulder impingement and bursitis are common causes of pain in the upper arm and shoulder, particularly during overhead movement. Both conditions involve irritation of the soft tissues within the subacromial space, the narrow area between the top of the upper arm bone (humerus) and the overlying bony arch of the shoulder (acromion).
Shoulder impingement occurs when the rotator cuff tendons become pinched or compressed during arm elevation. This repeated friction can lead to inflammation and pain.
Subacromial bursitis refers to inflammation of the bursa, a small fluid-filled sac that cushions the tendons and reduces friction within the shoulder. These conditions frequently occur together and may also be associated with rotator cuff pathology.
What causes shoulder impingement and bursitis?
Shoulder impingement and bursitis may develop from a variety of causes, often related to repetitive overhead activity or gradual wear and tear:
- Repetitive shoulder motion (e.g. swimming, painting, or certain gym exercises)
- Shoulder muscle imbalances or postural problems
- Bone spurs or thickening of the acromion narrowing the subacromial space
- Rotator cuff weakness or partial tears
- Poor scapular (shoulder blade) control
- Acute injuries or overuse following a sudden increase in activity
Age-related changes in shoulder mechanics can also contribute, particularly in individuals over 40.
Common symptoms of shoulder impingement or bursitis
The symptoms of impingement and bursitis tend to overlap, and may include:
- The symptoms of impingement and bursitis tend to overlap, and may include:
- Pain when lifting the arm, particularly overhead or out to the side
- Weakness or difficulty performing certain activities (e.g. dressing, reaching)
- A catching or grinding sensation with movement
- Reduced range of motion
If symptoms persist or worsen despite rest and simple measures, further assessment is advised.
How is shoulder impingement or bursitis diagnosed?
Dr Jason Hockings will begin with a thorough clinical examination of your shoulder, reviewing your symptoms, range of motion, and rotator cuff strength.
Imaging such as X-rays may be used to check for bone spurs or structural narrowing. Ultrasound or MRI can help confirm inflammation of the bursa, detect fluid buildup, and identify any coexisting rotator cuff tears.
A diagnostic injection of local anaesthetic into the subacromial space may also be used — temporary pain relief following the injection supports the diagnosis of impingement or bursitis.
Non-surgical treatment options
Many cases of shoulder impingement and bursitis respond well to non-surgical treatment, especially when addressed early. Dr Hockings may recommend:
- Rest and activity modification to avoid aggravating movements
- Anti-inflammatory medications to reduce swelling and discomfort
- Targeted physiotherapy to improve posture, shoulder blade control, and rotator cuff strength
- Corticosteroid injection into the subacromial bursa to settle inflammation
- Ice therapy and gentle stretching to relieve pain and maintain mobility
Most patients experience improvement within weeks with the right rehabilitation program.
When might surgery be recommended?
Surgery may be considered if your symptoms persist despite a full course of non-operative management, or if imaging reveals structural narrowing, rotator cuff damage, or significant mechanical impingement that is unlikely to resolve with physiotherapy alone.
Dr Hockings will discuss the role of surgery only after careful consideration of your condition, lifestyle, goals, and response to conservative treatment.
What does shoulder decompression surgery involve?
If non-surgical options are not effective, arthroscopic subacromial decompression may be recommended. This is a minimally invasive (keyhole) procedure performed under general anaesthetic. Using a small camera (arthroscope) and specialised instruments inserted through tiny incisions, Dr Hockings removes inflamed tissue from the bursa and smooths the underside of the acromion bone. This creates more space for the rotator cuff to move freely, reducing mechanical friction and inflammation.
The surgery is usually performed as a day procedure, and recovery is generally quicker than with rotator cuff repair. Many patients resume light activities within a few weeks, with full recovery taking several months depending on your rehabilitation progress.
Rehabilitation after decompression involves:
- Sling support for comfort in the first few day
- Early physiotherapy to restore range of motion
- Progressive strengthening exercises over 6–12 weeks
While most people experience relief from symptoms, all surgery carries some risks, including infection, stiffness, incomplete pain relief, or recurrence. Dr Hockings will discuss these with you and provide a tailored post-operative care plan to support your recovery.
If you’re experiencing ongoing pain, stiffness, or reduced movement that is affecting your daily activities or quality of life, a thorough orthopaedic assessment can help determine the cause and guide the most appropriate treatment options for your situation.