Approximately 0.4% of primary care visits are related to bursitis, and the shoulder is one of the most commonly affected joints, particularly in people who perform repetitive movements with their arms above their heads.

Here's the good news: shoulder bursitis resolves naturally in the vast majority of cases with appropriate treatment. Your shoulder is more resilient than you think, and this condition is rarely serious.

You will discover what shoulder bursitis really is, why it occurs, how to recognize it, and, most importantly, how to speed up your recovery and regain full mobility.

What is shoulder bursitis?

Shoulder bursitis is inflammation of a bursa—a small, thin sac filled with fluid that acts as a cushion between the structures of your joint. In the shoulder, the most commonly affected bursa is the subacromial bursa, located between the acromion (part of the shoulder blade) and the rotator cuff tendons.

This bursa reduces friction when you raise your arm, allowing the tendons to slide freely under the bone. When it becomes inflamed, this sliding mechanism becomes painful and limited.

The subacromial bursa is involved in approximately 80% of cases of shoulder bursitis. This condition affects both men and women and occurs more frequently in adults aged 40 to 60 who engage in activities that require repetitive shoulder movements.

If you recognize these characteristics, you are probably wondering what distinguishes acute bursitis from chronic bursitis—an important distinction for understanding your own situation.

Is my bursitis acute or chronic?

Acute bursitis develops rapidly—often within hours or days—following a specific triggering event: direct trauma to the shoulder (fall, blow), unusually intense exertion (moving house, painting the ceiling), or sudden repetitive movement. Symptoms appear suddenly: sharp pain, sometimes visible swelling, and marked difficulty raising the arm. Acute bursitis generally responds very well to treatment and resolves within 2 to 6 weeks. Chronic bursitis develops gradually over several weeks or months. It results from repeated microtrauma—a painter who works on ceilings every day, a swimmer who trains intensively, or a factory worker who performs the same movements with their arms raised for years. The symptoms are more insidious: dull pain that comes and goes, progressive stiffness, recurring nighttime pain. Chronic bursitis can persist for several months and requires a more structured treatment approach.

Now that you understand the difference between these two types, let's explore what actually causes this inflammation.

What REALLY causes shoulder bursitis?

Many people think that bursitis comes "out of nowhere" or is simply due to aging. This is not true. Your bursitis has a specific cause—and understanding it is liberating, because it means you can take action to promote healing.

Shoulder bursitis is not a mysterious condition. It is your body's normal inflammatory response to excessive irritation of the bursa. Three main mechanisms cause this irritation:

1. Impingement syndrome This is the most common cause. When the space between your acromion and the rotator cuff tendons is reduced—due to poor posture, muscle imbalance, or the particular shape of your acromion—the bursa gets "pinched" every time you raise your arm. Repeated hundreds of times a day, this pinching causes inflammation. 2. Repetitive movements with arms above the head : Every time you raise your arm above 90 degrees, your bursa should slide under the acromion. If you perform this movement hundreds or thousands of times—painters, swimmers, volleyball or tennis players—excessive friction irritates the bursa, even if your anatomy is normal. 3. Direct trauma A direct blow to the shoulder (fall, sports accident, collision) can cause immediate bleeding or inflammation in the bursa. This is less common, but when it happens, bursitis develops quickly.

More rarely, bursitis can be caused by a bacterial infection (septic bursitis), a systemic inflammatory disease such as rheumatoid arthritis or gout, or calcium deposits in adjacent tendons.

The liberating truth: Your bursitis is not due to weakness in your body. It is a normal reaction to excessive mechanical stress. Your body is not broken—it is responding logically to what you are asking it to do. You can take action to change these mechanical factors.

Before we look at how to treat this condition, let's learn how to recognize its distinctive signs.

What are the symptoms of shoulder bursitis?

The symptoms of shoulder bursitis generally follow a predictable pattern. Here are the signs to look out for:

Pain on the side or front of the shoulder This is the cardinal symptom. The pain is typically located on the outer side of the shoulder, sometimes slightly toward the front. You can often point to the exact spot that hurts. This pain is usually described as a burning or stabbing sensation. Painful arc when raising the arm Slowly raise your arm to the side, as if you were going to touch your ear. If you feel sharp pain between 60 and 120 degrees of elevation (between waist height and the height of the opposite shoulder), and then this pain decreases as you continue to raise your arm, this is very characteristic of subacromial bursitis. This is called the "painful arc." Nighttime pain Many report that their bursitis wakes them up at night, especially when they lie on the affected shoulder. This nighttime pain is due to direct pressure on the inflamed bursa. It is a sign of active inflammation. Morning stiffness When you wake up, your shoulder may feel "stuck" or very stiff for the first 15 to 30 minutes. This stiffness usually decreases with gentle movement. It reflects the accumulation of inflammatory fluid in the bursa during the night. Difficulty with daily activities Simple movements become difficult: fastening your bra, reaching for something on a high shelf, combing your hair, throwing a ball. Any activity that requires raising your arm above your head becomes problematic. Apparent weakness It's not a real muscle weakness. Your muscles are intact. But the pain inhibits muscle contraction—your brain "cuts off" the strength to protect the shoulder.

If you recognize several of these symptoms, you are probably wondering how to confirm the diagnosis with certainty.

How is shoulder bursitis diagnosed?

The diagnosis of shoulder bursitis is based primarily on a clinical examination performed by a healthcare professional—your doctor or physical therapist.

Medical history Your healthcare provider will ask you specific questions about when the pain started, whether there was a triggering event, what movements increase or decrease the pain, whether you experience pain at night, and about your work or sports activities. This information greatly influences the diagnosis. Clinical trials Several maneuvers can reproduce the pain characteristic of bursitis. The painful arc test involves passively lifting your shoulder to the side—pain between 60 and 120 degrees strongly suggests subacromial bursitis. The Neer and Hawkins-Kennedy tests confirm subacromial impingement, likely involving the bursa. Medical imaging X-rays rule out fractures and detect bone spurs or calcium deposits. Ultrasound is the preferred examination for directly visualizing the bursa and showing thickening or fluid accumulation. MRI is reserved for complex cases. Please note: Imaging can sometimes show signs of bursitis in people who have no symptoms. Up to 20% of people without symptoms have abnormalities in the bursa on ultrasound. The diagnosis is based primarily on your medical history and symptoms.

Now that the diagnosis is clear, let's see how to effectively treat this condition.

What are the treatments for shoulder bursitis?

Treatment for shoulder bursitis follows a step-by-step approach, always starting with the most conservative interventions.

Phase 1: Management of acute inflammation (0-2 weeks)

Modify your activities wisely—this is not complete rest. Temporarily avoid movements that trigger pain (arms above the head), while maintaining movements within comfortable ranges. Complete immobilization can lead to stiffness.

Apply ice for 15 minutes, 3 to 4 times a day. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help during the acute phase. In very painful cases, a triangular bandage can be used for 24 to 48 hours.

Phase 2: Active physical therapy (2–8 weeks)

This is the cornerstone of treatment. Your physical therapist will create a personalized plan that includes manual therapy, progressive mobility exercises (pendulum swings, wall slides), targeted strengthening of the rotator cuff and shoulder blade, and postural correction. A forward-rolled posture reduces the subacromial space and perpetuates the problem.

Phase 3: Medical interventions (if necessary)

If the pain persists despite 6 to 8 weeks of physical therapy, a cortisone injection directly into the bursa may be recommended. The effect is usually rapid and can last from several weeks to several months. A maximum of one to two injections are recommended.

Surgery is rarely necessary. It is only considered in chronic cases that do not respond to conservative treatment after 6 to 12 months. Full recovery usually takes 3 to 6 months.

Your physical therapist can guide you through each step. But there are also simple things you can do at home.

What can you do at home to relieve your bursitis?

If your bursitis is caused by trauma Follow the PEACE and LOVE principles. Protection: avoid movements that significantly increase pain for 2-3 days. Elevation: slightly raise your arm on a pillow. Load: start moving gently again as soon as possible with pendulum movements. Vascularization: walk, ride a stationary bike with your arm supported. Exercise: Gradually progress to mobility exercises as advised by your physical therapist. If your bursitis is NOT caused by trauma Identify and modify repetitive activities that may have caused your bursitis. Temporarily reduce the frequency or intensity. Use the "2 hours/24 hours" rule: If an activity increases your pain and that pain lasts more than 2 hours after the activity or is worse the next morning, you have overdone it. Strategies for nighttime pain Avoid sleeping on the painful shoulder. If you sleep on the opposite side, place a pillow in front of you and rest your injured arm on it. If you sleep on your back, place a small pillow under your arm. Make sure your neck is properly aligned. Keep your bedroom cool (64-68°F) and avoid caffeine and alcohol in the evening. Simple exercises Pendulum movements (days 1-7) involve leaning forward slightly, letting your injured arm hang freely, and gently swinging it. Do this for 2-3 minutes, 3 times a day. Wall slides (week 2+) are done standing facing a wall, slowly sliding your hands up as high as possible without excessive pain. Repeat 10 times, twice a day.

These basic exercises are not a substitute for a personalized physical therapy program, but they are an excellent starting point. Now you're probably wondering how long all this will take.

How long does shoulder bursitis last?

Most shoulder bursitis cases heal within 4 to 8 weeks with appropriate treatment, especially if treatment is started quickly. This is particularly true for healthy young adults, acute bursitis caused by isolated overuse, and people who follow treatment recommendations.

Some mild cases of bursitis can resolve within 2 to 4 weeks with rest, ice, and gentle exercises.

Chronic bursitis or bursitis associated with other shoulder problems may require 3 to 6 months of conservative treatment. If surgery is necessary, full recovery usually takes an additional 3 to 6 months.

Factors that influence your recovery time : Your age and general health, the speed of diagnosis and treatment, your adherence to the treatment plan, the presence of associated conditions (rotator cuff tendinopathy, severe impingement syndrome, osteoarthritis), and your type of work or activities.

If your pain persists beyond 6 weeks despite following conservative treatment, consult a healthcare professional again to reassess your condition.

When should you see a physical therapist for shoulder bursitis?

You should consult a physical therapist if you experience the symptoms described above (lateral shoulder pain, painful arc, nighttime pain), if your pain persists for more than a week despite rest, if your mobility is significantly limited, or if nighttime pain regularly disrupts your sleep.

Important: In Quebec, you do NOT need to see a doctor before consulting a physical therapist. Physical therapists are front-line professionals trained to assess and treat musculoskeletal disorders. If your condition requires medical consultation, your physical therapist will let you know.

During your first visit, your physical therapist will conduct a comprehensive assessment: joint mobility, quality of movement (scapulohumeral rhythm), strength and stability, nerve gliding, and posture. Based on this assessment, your physical therapist will create a personalized treatment plan tailored to your goals, physical condition, and lifestyle constraints.

If you have shoulder pain from a different source, check out our comprehensive guide to shoulder pain, which explores all possible causes. To learn more about treatment approaches, see our article on physical therapy for shoulder pain.

Since bursitis is often associated with impingement syndrome, we have created a comprehensive guide to shoulder impingement syndrome that explains this mechanism in depth and how to treat it.

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