It's ONLY bursitis, nothing a little cortisone won't fix...

I've heard this a few times. And it really really annoys me.

What people fail to understand, is that cortisone is like a pain-relieving Band-Aid and that the problem is likely to recur somewhere down the track. If you don't figure out the WHY behind the bursitis, you probably will struggle to overcome it. Don't get me wrong, cortisone can be beneficial for some chronic conditions but the mechanics of why the problem started in the first place still needs to be investigated.

Bursitis in the shoulder is one of the most common causes of shoulder pain and the sub-acromial bursa is usually the culprit. The sub-deltoid bursa can also be a cause of shoulder pain but is less commonly seen.

So what is a bursa exactly?

A bursa is a fibrous sac located around tendons and the underlying bones in numerous locations in the body. Its main role is to act as a cushion between the tendon and bone, providing a smooth surface for the tendon to glide. When the bursa becomes inflamed, it fills with fluid, causing pain and restriction of movement.


There are a few things that can cause sub-acromial bursitis in the shoulder:

• repetitive overhead movements - overuse injury
• trauma - such as a fall
• poor shoulder biomechanics - poor posture, rounded shoulders, etc.
• weakness of scapular stability muscles such as rhomboids, lower traps
• weakness of rotator cuff - particularly subscapularis**
• tightness of the posterior capsule of the shoulder
• bony abnormality such as osteophytes, hooked acromion (primary external impingment)

I'm not going to discuss each of the points listed above, but do want to talk about the subscapularis muscle, which is a muscle of the rotator cuff, most commonly known as an internal rotator of the shoulder. However, the most important role of this muscle is to compress the humeral head into the glenoid fossa and prevent anterior and superior translation of the shoulder during functional activities. Restriction of the subscapularis muscle will limit external rotation ROM and trigger points in this muscle can refer pain into the back of the shoulder and down into the wrist.

Subscapularis trigger point referral pattern

There are a few tests to assess the subscapularis for tears - check out the link for the tests.
http://eorif.com/subscapularis-physical-exam. However, the subscap push off test is more a test of subscapularis strength. Try this at home to see if your subscapularis is working or not:

• Stand 3/4 of a foot length away from a wall
• Place one hand behind you, just in your lower back
• Keep your head and thoracic spine against the wall
• Bring your elbow forward so it is NOT resting against the wall
• Now, using only the heel of the hand (not the fingers), attempt to lift yourself away from the wall WITHOUT ALLOWING THE ELBOW TO DRIFT BACKWARDS
• Do not use your fingers or wrist to initiate the movement and do not allow the body to lean forward or head poke

 An inability to perform this test may be indicative of a weak subscapularis muscle.  If you cannot get your hand behind your back for this test, you either need to work on your internal rotation ROM or perhaps get further investigation for possible tear of subscapularis. For athletes requiring good rotator cuff strength, i.e. Crossfitters, you should be able to perform this movement properly 8-10 times. How many can you do??

So, if you are suffering with shoulder pain and the diagnosis is bursitis, I would think long and hard about getting that cortisone shot your Doctor will likely offer you. Yes, it may relieve your pain in the short term, but if you want it fixed permanently you need to address your faulty biomechanics and a lazy subscapularis.