Subacromial Impingement and Bursitis Info

Q: Is shoulder bursitis the same as a rotator cuff tear?

Not exactly, but they overlap. Subacromial bursitis is inflammation of the bursa above the rotator cuff; rotator cuff tendinopathy is degeneration of the cuff tendons themselves; rotator cuff tear is a structural tear of one or more cuff tendons. These conditions are part of a continuum and frequently co-exist — bursal inflammation often accompanies a cuff tear, and isolated bursitis can progress to tendinopathy and partial tearing over years. MRI helps distinguish them, but the consult's job is matching treatment to the dominant problem in any given patient.

Q: Will physiotherapy work, or do I need surgery?

For most patients with subacromial pain — bursitis, impingement, or mild tendinopathy without a structural tear — structured physiotherapy works. Published trials over the past decade have repeatedly shown that arthroscopic decompression often does not outperform a thorough non-operative programme. That said, surgery has a clear role when there is a structural tear, a calcific deposit, an os acromiale, or persistent disabling symptoms despite a structured trial. The first consult sets out where the patient sits and what to try first.

Q: What does a corticosteroid injection do?

A subacromial corticosteroid injection is a clinic-based procedure that delivers a small dose of steroid into the bursa above the cuff. It settles inflammation and reduces pain, often substantially, for weeks to months. It does not fix a structural tear, but it can break the pain cycle long enough for physiotherapy to make progress. Repeat injections are limited — usually no more than two or three at the same site — because of evidence that frequent steroid injections weaken tendons over time.

Q: How long is the recovery from decompression alone?

After isolated arthroscopic decompression, most patients are out of the sling within a week and back to office work in seven to ten days. Driving is reasonable once the shoulder is comfortable. Physical activities and lifting are graded back over four to six weeks. Final settlement is usually around three months. Recovery is faster than after a rotator cuff repair because there is no tendon to protect.

Q: What if I also have a rotator cuff tear?

If MRI shows a structural cuff tear, the operation typically combines decompression with cuff repair — see the [rotator cuff repair page](/conditions/rotator-cuff-repair/). The recovery follows the cuff-repair pathway: six weeks in a sling, gradual range-of-motion over the next six weeks, and strengthening over months. The decompression and repair are done at the same operation through the same arthroscopic portals.

Q: How much does shoulder bursitis surgery cost? What does Medicare cover?

Arthroscopic subacromial decompression is performed under regional and general anaesthesia at Mater Private Hospital Rockhampton, so a separate anaesthetist gap applies on top of the surgeon and hospital fees. The practice quotes the surgical fee in writing before booking — Medicare item, rebate and out-of-pocket gap shown separately. Most major funds offer no-gap arrangements. Surgery does not proceed without itemised written informed financial consent.

Subacromial impingement — causes of shoulder pain with overhead activity, diagnosis, and treatment options.

What you're feeling

You likely have pain in the top and outer side of your shoulder. This pain often feels deep inside the joint. It may flare up when you reach overhead or lift things. Many people notice the pain gets worse at night. You might find it hard to sleep on the side of your shoulder. Waking up with a stiff shoulder is common.

Daily tasks can become difficult without warning. Reaching behind your back to fasten a bra may hurt. Tucking in a shirt can trigger sharp pain. Simple movements like washing your hair or putting on a coat might feel awkward. Your surgeon will check if you have mechanical impingement. This means a bone or tissue is rubbing where it should not. You may have had pain for at least 6 months without relief from non-surgical measures.

The pain often starts after activity and lingers into the evening. Some days are better than others, but the discomfort can return quickly. You might feel a dull ache that turns sharp with specific motions. If you have had persistent symptoms, your surgeon will look for signs of wear-and-tear arthritis or tendon issues. Proper selection of patients leads to excellent outcomes. However, if your pain does not improve with rest or therapy, surgery may be considered.

What's actually happening

Imagine your shoulder has a narrow tunnel where a rope of tendon fibers passes. This tunnel is formed by a bony arch and a tough ligament above it. When you lift your arm, the space in this tunnel shrinks. If the space becomes too tight, the tendon gets pinched or "impinged" against the bone and ligament. This rubbing causes inflammation in the soft cushion called the bursa, which sits between the tendon and the bone.

Over time, this repeated pinching can wear down the tendon. Sometimes, calcium deposits build up inside the tendon, making it stiff and painful. Your surgeon looks for signs that this mechanical pinching is real, such as pain when you lift your arm high or a specific test that reproduces your symptoms. If you have had pain for at least 6 months and non-surgical treatments have not helped, surgery might be considered to widen this tunnel.

The surgery involves removing a small part of the bone and the ligament to create more room. This reduces the friction on the tendon. However, removing bone changes how your shoulder muscles work. It can increase the force your rotator cuff needs to lift your arm by 25% to 30%. For some people, this extra effort is manageable. For others, especially if the tendon is already torn, simply widening the tunnel might not be enough. In cases of a full-thickness tear, repairing the tendon itself often improves comfort and function without needing to remove bone.

What we can do about it

Your journey usually begins with self-care and physiotherapy. This conservative management is the main first step for subacromial impingement syndrome. Your physiotherapist will guide you through exercises to strengthen the shoulder muscles and improve movement. You should give this non-surgical approach a fair chance before considering an operation. If your pain does not improve after at least six weeks of this care, your surgeon may discuss other options.

If simple exercises are not enough, your surgeon might suggest medical treatments to manage your pain. These can include anti-inflammatory medications or injections into the shoulder bursa. A cortisone injection can provide effective pain relief and is often used to help you participate in physiotherapy. Some patients also receive a suprascapular nerve block to reduce overall pain and the need for painkillers. While these treatments can help, they do not fix the underlying mechanical issue if your shoulder is being pinched.

Surgery is reserved for cases where non-surgical measures have failed to help you. Your surgeon will consider subacromial decompression if you have had pain for at least six months and tests show mechanical impingement. This procedure removes a small amount of bone to create more space in your shoulder. It is a valid option that can reduce pain and improve your quality of life for carefully selected patients.

When to see someone

See your GP if shoulder pain lasts for at least 6 months and does not improve with rest. Ask for a specialist review if you have a persistently positive Hawkins test or X-ray signs of mechanical impingement. Seek help if pain keeps you from sleeping or working. You may need surgery if conservative treatment fails. Your surgeon will check for weakness, locking, or sudden worsening. If you have calcific deposits, recovery may take longer to return to pain-free activity.