What is Subacromial Bursitis?

There are approximately between 7 to 12 bursae (fluid filled sac) around the shoulder joint helping to decrease friction between shoulder joint structures during normal movements.

The subacromial/subdeltoid, subcoracoid and subscapular bursa commonly referred to in the literature, could be described in lay man’s terms as the “oil in the engine”. The subacromial bursa then facilitates the smooth movement of the rotator cuff under the acromion and is inneravted by the superior articular branch of the suprascapular nerve (C5/6) and the articular branch of the lateral pectoral nerve (C5/6).

subacromial-bursa-injection

The subacromial bursa, whilst highly nocioceptive (produces pain signals to the brain) it is also proprioceptive and involved in the sensory motor control of the shoulder. The normal bursa is filled with free nerve endings, capable of responding at varying speed to a variety of stimuli, for example pain, temperature, stretch and pressure. The best evidence suggests, in the inflamed bursa, an increased density of free nerve endings, and pro-inflammatory chemicals (e.g. cytokines & substance P) that correlate with increased pain and may have a catabolic (negative) effect on rotator cuff tendon tissue.

It seems that the subacromial bursa is a primary pain generator of the shoulder and is likely to be involved in subacromial impingement, reactive rotator cuff tendinopathy and rotator cuff tears. All movements of the shoulder will stretch and/or compress the bursa under normal use but once inflamed the bursa may play a significant role in perpetuating shoulder pain and dysfunction.

The early focus of shoulder rehabilitation should be to decrease the inflammatory response and reduce pain to an acceptable level to better facilitate early physiotherapy intervention.

 

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