A bursa is a small flat cushion-like structure, one to three inches in size, usually found in between a muscle and a bone. It helps provide protection and less friction. It is sometimes thought of as a small fluid filled cushion, but usually it is quite flat, similar to a barely filled plastic bag of water. These are present in many areas of our skeletal system, and are especially famous for causing problems in hips, shoulders, elbows and knees.
Pain will occur when the bursa becomes injured, pinched or inflamed. When the bursa is inflamed, it is called bursitis (the 'itis' refers to something that is inflamed - like appendicitis). When the bursa is inflamed or injured the lining of the bursa produces more fluid and it swells up, causing severe shoulder bursitis.
In the shoulder, the main bursa is under the tip of the collarbone. This may become painful when there are problems in the rotator cuff muscle just under it. Strenuous or repetitive activities may cause inflammation of the bursa in this case. An injury in this area from unusually heavy or sudden stretching of the arm or falling may cause bursitis also. Frequently, activities such as prolonged overhead use of the arm (such as painting or pruning trees) may lead to problems with bursitis. Calcium deposits or 'bone spurs' may develop on the undersurface of the collarbone joint near the point of the shoulder can hang down and rub or pinch the bursa underneath it. If the bursa is pinched by a bone spur in the shoulder it is called impingement syndrome. Sometimes shoulder bursitis is due to a more serious disease, such as rheumatoid arthritis or even infection.
When the shoulder is at rest there is less pain, but it usually will feel painful with raising the arm overhead, to the front or side, or lying on the shoulder at night. Pain may actually be felt most on the side of the upper arm, sometimes down almost to the elbow. The pain may be very sharp if the bursitis is severe.
Along with a history of the shoulder symptoms, an examination using specific motions may suggest severe shoulder bursitis is present. Usually X-rays are done, but because the bursa is made of soft tissue, X-rays or CT scans are often not sufficient. An MRI often shows if bursitis is present.
The treatment of bursitis depends upon how severe the pain is. In general, if pain does not improve with ice and rest, then medical evaluation is a good idea. Physical therapy and anti-inflammatory medications may be tried to reduce pain. If the symptoms do not improve, X-rays, MRI or ultrasound tests may be ordered to make sure rotator cuff is not involved as well.
If you develop shoulder pain with exercise or exertion, please contact your physician as this may be a sign of heart disease.
Various medications may be used to reduce pain. These may include over the counter medications such as Tylenol (generic = acetaminophen) Aleve (generic = naproxen), Motrin (generic = ibuprofen) or aspirin. There are many similar (but stronger) prescription non-steroidal anti-inflammatory medications for bursitis such as Celebrex, ibuprofen or naproxyn (NSAIDs) that may help to reduce pain and inflammation; a complete list is available at the reference below.
More severe pain may be treated with injections of cortisone-like medications into the bursa underneath the end of the collarbone . Rarely, arthroscopic surgery may be required to remove the bursa and calcium deposits.