Shoulder Bursitis and Tendonitis: Causes, Symptoms & Treatment Options

Understanding Shoulder Bursitis and Tendonitis

Though bursitis and tendonitis are distinct conditions, they share many similarities in terms of causes, symptoms, and treatment, and they are often present simultaneously. Understanding the difference between the two can help clarify why certain treatments are recommended.

What Is Shoulder Bursitis?

The shoulder contains a fluid-filled sac called the subacromial bursa, which sits between the rotator cuff tendons and the acromion bone above. Its job is to reduce friction and allow the rotator cuff to glide smoothly during arm movement. When the bursa becomes irritated and inflamed — a condition called bursitis — it swells and takes up space in an already tight area, causing pain and impingement with shoulder movement.

Common causes of shoulder bursitis include:

• Repetitive overhead activity that pinches the bursa between the rotator cuff and the acromion
• Direct trauma or a fall onto the shoulder
• Age-related changes in shoulder anatomy, such as bone spurs on the acromion
• Underlying inflammatory conditions such as rheumatoid arthritis
• Prolonged pressure on the shoulder

What Is Shoulder Tendonitis?

Shoulder tendonitis refers to inflammation of one or more of the rotator cuff tendons, most often the supraspinatus tendon, which runs through the subacromial space. It is most commonly caused by repetitive overhead activity, poor shoulder mechanics, or gradual age-related tendon degeneration. Over time, untreated tendonitis can weaken the tendon and increase the risk of a rotator cuff tear.

Common causes of shoulder tendonitis include:

• Repetitive overhead movements in sport or at work
• Poor posture that alters shoulder mechanics and increases tendon stress
• Muscle imbalances that place uneven load on the rotator cuff
• Age-related tendon degeneration and reduced blood supply to the tendon

Shoulder Bursitis and Tendonitis Symptoms

Bursitis and tendonitis often produce overlapping symptoms, which is one reason they are frequently found together. Common symptoms include:

• A dull ache or sharp pain in the outer shoulder or upper arm
• Pain that worsens with overhead activity, reaching, or lifting
• Tenderness when pressing on the outer edge of the shoulder
• Stiffness and reduced range of motion, particularly with overhead movement
• Pain that is worse at night, especially when lying on the affected shoulder
• Weakness in the shoulder during activity

Because these symptoms can resemble those of other shoulder conditions such as AC joint arthritis and frozen shoulder, an accurate diagnosis from an experienced shoulder pain specialist is essential before beginning any treatment.

Shoulder Bursitis and Tendonitis Treatment Options

Most cases of shoulder bursitis and tendonitis respond well to conservative care. Treatment may include:

• Rest and activity modification to reduce ongoing irritation and allow inflammation to settle
• Anti-inflammatory medications to manage pain and swelling
• Physical therapy to improve shoulder strength, posture, and mechanics, addressing the underlying contributors to the condition
• Corticosteroid injections for targeted, effective relief when other measures are insufficient; these can also facilitate more productive participation in physical therapy
• Platelet-rich plasma (PRP) therapy as a supportive orthobiologic option for chronic or resistant cases

When conservative care has been exhausted and symptoms persist, surgical treatment may be considered. The most common procedure for bursitis and impingement is arthroscopic subacromial decompression, in which inflamed bursal tissue is removed and any bone spurs contributing to impingement are addressed. Dr. Duany performs this procedure using a minimally invasive approach that offers a more efficient recovery for her patients. Surgery is rarely needed for isolated tendonitis, but when significant tendon damage is present, it may be addressed at the same time.