Many non-operative treatments have been advocated, including rest; oral administration of non-steroidal anti-inflammatory drugs; physical therapy; chiropractic; and local modalities such as cryotherapy, ultrasound, electromagnetic radiation, and<unk>  injection of corticosteroids. Shoulder bursitis rarely requires surgical intervention and generally responds favorably to conservative treatment. Surgery is reserved for patients who fail to respond to non-operative measures. Minimally invasive surgical procedures such as arthroscopic removal of the bursa allows for direct inspection of the shoulder structures and provides the opportunity for removal of bone spurs and repair of any rotator cuff tears that may be found. Early / initial Initial phase of physiotherapy rehabilitation Goals of treatment * Reduce inflammation * Reduce pain * Prevent weakness and atrophy of muscles as a result of disuse * Increase the patient’s awareness of bursitis * Prevent/reduce impingement and further tissue damage Treatment Justification Advice and education Educate the patient about their condition and advise to avoid painful activities and the importance of relative rest of the shoulder Prevention of pain and impingement which delays the healing process Educate the patient about the importance of correct posture Puts muscles in the optimal length tension relationship, reducing impingement Manual therapy Grade 1 and 2 accessory mobilisations of the glenohumeral joint Has a neurophysiological effect reducing pain and improving synovial fluid flow, improving healing Soft tissue massage Lengthens tight muscles and reduces muscle spasm Therapeutic exercise Gentle pendulum range of motion exercises Maintenance of range of motion and prevention of adhesive capsulitis Scapular exercises such as shoulder shrugs and shoulder retraction exercises Improve muscular control and scapular coordination Centering of humeral head Helps to facilitate adequate muscle timing and recruitment Stretching of tight muscles such as the levator scapulae, pectoralis major, subscapularis and upper trapezius muscle To lengthen tight muscles which may improve scapulohumeral rhythm, posture and increase the<unk>  space Rotator cuff strengthening - isometric contractions in neutral and 30 degrees abduction Improves rotator cuff strength which is integral to the stability of the shoulder and functional activities Electrophysical modalities Ice To reduce inflammation and pain elevate Low intensity pulsed ultrasound (3 megaHz) To reduce inflammation and facilitate healing External physical aids May use head of humerus repositioning tape To maintain the head of humerus in its central position for optimal muscle recruitment Middle / intermittent Intermittent phase of physiotherapy rehabilitation Goals of treatment * Improve muscle control * Improve scapulohumeral rhythm * Improve active and passive range of motion * Restore strength of scapular and rotator cuff muscles Treatment Justification Advice and education Advise the patient that they must perform all activities and exercises pain free To prevent reinjury and damage to the bursa Manual therapy Grade 3 and 4 accessory mobilizations of the glenohumeral joint Improves range of motion and increases synovial fluid movement, improving healing Proprioceptive neuromuscular facilitation (PNF) in functional diagonal patterns Strengthens muscles, improves motor control and scapulohumeral rhythm Mobilization with movement e.g. caudal glide with active abduction Improves range of motion and decreases pain Therapeutic exercise Specific muscle strengthening exercises especially for scapular stabilization (serratus anterior, rhomboids and lower trapezius muscles) e.g. strengthening lower trapezius muscle - bilateral external rotation using a theraband, strengthening of serratus anterior, punching with theraband resistance Improves stability during scapular motion which may decrease impingement of the bursa in the<unk>  space. Active assisted range of motion - creeping the hand up the wall in abduction, scaption and flexion and door pulley manoeuvre Help to improve active range of motion and gravity assists with shoulder depression Active internal and external rotator exercises with the use of a bar or a theraband Improves strength of rotator cuff and improves mobility in internal and external rotation Electrophysical modalities Heat Improves muscle extensibility Low intensity pulsed ultrasound (3 megaHz) Facilitates healing External physical aids May use head of humerus repositioning tape if necessary To maintain the head of humerus in its optimal position for optimal muscle recruitment Late / return to function Return to function phase of physiotherapy rehabilitation Goals of treatment * Return the patient to their previous level of function * Achieve full active and passive range of motion Treatment Justification Education and advice Education about the importance of a home based exercise program in the late stage of rehabilitation Ensures patient compliance Correction of techniques performed Ensures that the correct target muscles are being used Education to ensure that the patient performs activities and exercises within pain free limits This reduces the chance that the patient may work too hard and cause reinjury Manual therapy PNF functional patterns with increasing resistance Continues to strengthen muscles, improves motor control and scapulohumeral rhythm Therapeutic exercise Exercises specific for the patient’s functional needs e.g. functional reaching To improve the patients functional ability Proprioception exercises e.g. Wall push ups with the hands resting on medicine balls or dura disks Improves proprioception important to reduce reinjury as return to function/sport Strengthen the shoulder elevators – deltoid, flexors and also latissimus dorsi. Important in this phase of the rehabilitation following strengthening of the shoulder depressors Progress strengthening exercises to incorporate speed and load to make more functional Adding speed and load to exercises ensures that the patient is prepared for more functional tasks and activities Electrophysical modalities Ice after exercise May assist to reduce any inflammation post exercise External physical aids May use head of humerus repositioning tape if necessary May assist with return to function
Subacromial bursitis
Rotator cuff tear
Ischial bursitis
Retrocalcaneal bursitis
Infrapatellar bursitis
Pes anserine bursitis
Calcific tendinitis
Olecranon bursitis