Shoulder Bursitis/Tendonitis: Early Signs, Treatment, and Exercises

You play tennis on a weekly basis and recently started noticing shoulder pain during your forehand.  A few more weeks go by and you now start noticing shoulder pain when overhead reaching, pushing open a heavy door, and sleeping on your side.  Shoulder pain can be pretty debilitating and annoying.  Shoulder bursitis and shoulder tendonitis are two of the most common shoulder conditions.  Let’s take a look at what they are and how physiotherapy can fix the issue.

Women rubbing shoulder and she may have shoulder bursitis or shoulder tendonitis.

What is shoulder bursitis?

Shoulder bursitis refers to the inflammation of the bursa in the shoulder joint. A bursa is a small, fluid-filled sac that helps reduce friction and allows smooth movement between bones, tendons, and muscles. When this bursa becomes irritated or inflamed, it can cause pain, swelling, and limited range of motion in the shoulder.

Common causes of shoulder bursitis include:

  • Overuse or repetitive movements: Activities involving repetitive overhead motions (such as painting, lifting weights, throwing sports) can strain the shoulder and lead to bursitis.
  • Trauma or injury: A direct blow to the shoulder or a fall can cause inflammation of the bursa.
  • Age-related changes: As people age, the bursa can become more susceptible to inflammation and irritation.
  • Other shoulder conditions: Conditions like rotator cuff tears, arthritis, or tendonitis can contribute to bursitis.

Symptoms of shoulder bursitis may include:

  • Pain: especially when reaching overhead or moving the arm. Pain that worsens at night, especially when lying on the affected shoulder.
  • Swelling: The affected area may be swollen or feel tender to the touch.
  • Stiffness: Limited range of motion in the shoulder joint.


What is shoulder tendonitis?

Shoulder tendonitis, also known as tendinitis, is a condition characterized by inflammation, irritation, or degeneration of the tendons in the shoulder. Tendons are tough, flexible bands of tissue that connect muscles to bones, enabling movement of the joints.

In the shoulder, tendonitis often affects the tendons of the rotator cuff or the biceps tendon. The rotator cuff is a group of muscles and tendons that surround the shoulder joint, providing stability and allowing a wide range of motion. When these tendons become inflamed or irritated, it canresult in shoulder tendonitis.

Common causes of shoulder tendonitis:

  • Overuse or Repetitive Movements: Continuous overhead arm motions, such as those involved in sports like tennis, swimming, or baseball, or work activities that require repetitive lifting or reaching overhead, can strain the shoulder tendons and lead to tendonitis.
  • Injury or Trauma: A sudden injury, such as a fall or direct impact to the shoulder, can cause tendon inflammation.
  • Age-related Changes: Tendons can degenerate and become less flexible with age, making them more prone to injury and inflammation.

Symptoms of shoulder tendonitis may include:

  • Pain: Often a dull ache in the shoulder that worsens with movement, especially when lifting the arm.
  • Swelling: The affected area may be swollen or feel tender to the touch.
  • Stiffness: Limited range of motion in the shoulder joint, making it difficult to raise the arm overhead.
  • Weakness: Difficulty performing activities that involve the affected shoulder due to weakness in the muscles or pain.


How is it treated?

Treatment for both shoulder bursitis and tendonitis are very similar.  Treatment for both conditions will involve manual therapy, exercises, and taking a break from aggravating activities.  If weight training is aggravating your shoulder your physiotherapist may ask you to take a break from training particular muscle groups that would aggravate the shoulder issue.  Commonly pushing and overhead movements would aggravate the shoulder.   Your physiotherapist may ask you to take a few weeks off of doing shoulderand chest exercises, however you may be able to continue bicep, back, and tricep exercises.  Your physiotherapist will discuss other activities that you can modify temporarily so your shoulder can get some much needed rest during your rehab.

Manual therapy, which means “hand on” treatment, will focus on stretching and massaging muscles in the front and back of the shoulder.  Manual therapy will release tension in the front of the shoulder that includes the pec major, subscapularis, and latissimus dorsi.  Muscles in the back of the shoulder such as the infraspinatus, teres major and minor will also be massaged by your physiotherapist to overall improve the flexibility of your shoulder so you can move freely again.  Traditional acupuncture and dry needling is also very effective at relieving muscle tension.  Your physiotherapist can discuss how acupuncture works and if you are a good candidate for acupuncture.


Common home exercises:

Isometric External Rotation Wall Slide:

The isometric external rotation wall slide is an exercise used to strengthen the rotator cuff muscles and improve shoulder stability. It primarily targets the external rotators of the shoulder, which are essential for maintaining proper shoulder function and preventing injuries.

Here’s how to perform the isometric external rotation wall slide:

Setup: Stand facing a wall and your feet should be about shoulder-width apart.  Hold either end of a resistance band with your elbow bent and your forearm touching the wall.

Execution:  Pull the bend apart with your hands by externally rotating your shoulder.  Slide your forearm up and down the wall while maintaining shoulder external rotation.  Repeat for 10-15 repetitions for 3-4 sets. 

Bryan Chen doing isometric external rotation wall slide exercise. This exercise is a rehab exercise for shoulder bursitis and shoulder tendonitis.

90/90 External Rotation to Overhead Press:

The 90/90 external rotation to overhead press is an exercise that combines two movements to strengthen the shoulder muscles.

Here are the steps to perform the 90/90 external rotation to overhead press:

Set up: Stand with feet shoulder width apart.  Hold onto a band.  With your elbows bent to 90 degrees abduct your shoulder to 90 degrees. 

Execution: Externally rotate your shoulder to 90 degrees so your forearm is facing forward to complete the first movement.  Punch your hand toward the ceiling to complete the 2nd movement.  Slowly lower your hand and internally rotate your shoulder to return back to the starting position.  Repeat for 10-15 repetitions for 3-4 sets.

Bryan Chen doing 90/90 shoulder external rotation to overhead press exercise. This exercise is a rehab exercise for shoulder bursitis and shoulder tendonitis.



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