Shoulder Bursitis: What It Is, What the Research Says, and How We Approach It in Hamilton
Shoulder pain is one of the most common musculoskeletal complaints presenting in primary care — accounting for a significant proportion of all musculoskeletal-related consultations globally (Zhao et al., 2024). Among the many structures that can contribute to shoulder pain, the subacromial bursa is one of the most frequently involved and yet it remains one of the least understood by the people experiencing it.
At MotionPlus Osteo in Hamilton, shoulder presentations are a regular part of our clinical week. This post explains what shoulder bursitis is, how it presents, what the current evidence says about management, and how we approach it as part of a broader osteopathic assessment.
What Is Shoulder Bursitis?
A bursa is a small, fluid-filled sac found at various locations throughout the body. Its job is to reduce friction between tissues, allowing tendons, muscles, and bones to glide smoothly over each other during movement (Faruqi & Rizvi, 2023). In the shoulder, the most clinically significant of these is the subacromial bursa, which sits between the rotator cuff tendons and the underside of the acromion the bony roof of the shoulder.
When this bursa becomes irritated or inflamed, the result is subacromial bursitis, a condition characterised by shoulder pain, stiffness, and difficulty with overhead or reaching movements. It commonly arises from repetitive overhead activity, sustained shoulder loading, direct impact to the shoulder, or as part of a broader picture of rotator cuff-related shoulder pain (Faruqi & Rizvi, 2023; Klatte-Schulz et al., 2022).
It's worth noting that in modern clinical thinking, subacromial bursitis is increasingly understood as part of a wider spectrum rather than a standalone diagnosis. The term rotator cuff-related shoulder pain (RCRSP) has become the preferred clinical label, as it acknowledges that the bursa, tendons, and surrounding structures rarely act in isolation (Powell et al., 2024).
How Does It Present?
Shoulder bursitis typically shows up as:
Pain on the outer side of the shoulder — often described as a dull ache at rest that sharpens with activity, particularly when lifting the arm out to the side or reaching overhead
Night pain — many people notice their shoulder is worse when lying on the affected side, which can significantly disrupt sleep
A painful arc — pain that occurs in a specific range of shoulder elevation, often between 60 and 120 degrees, and then eases again as the arm reaches higher
Stiffness and reduced range — particularly into internal rotation, which is often one of the earlier signs of subacromial involvement (Faruqi & Rizvi, 2023)
Weakness with overhead tasks — not always present, but common when the rotator cuff muscles are also involved
It's important to note that these symptoms can overlap with several other shoulder conditions including rotator cuff tendinopathy, calcific tendinitis, and glenohumeral joint pathology. A thorough clinical assessment is essential, as no single test or symptom pattern is sufficient for diagnosis (Zhao et al., 2024).
Who Is Most at Risk?
Shoulder bursitis and rotator cuff-related shoulder pain are particularly prevalent in:
Tradespeople — builders, electricians, painters, and plumbers who work with their arms elevated or in sustained overhead positions
Gym athletes — particularly those training pressing and overhead movements with high volumes
Desk workers — where sustained posture and reduced shoulder movement can contribute over time
Older adults — age-related changes to the rotator cuff tendons and bursa increase vulnerability, with prevalence rising significantly after the age of 40
Research suggests that between 44 and 65% of all shoulder pain presentations in primary care involve subacromial structures (Singh et al., 2022). This one of the most common shoulder complaints you will encounter in a Hamilton osteopathy clinic.
What Does the Research Say About Management?
The evidence base for shoulder bursitis management has strengthened considerably in recent years and the direction is clear: exercise is the cornerstone of conservative care.
A systematic review published in the Journal of Orthopaedic & Sports Physical Therapy concluded that exercise therapy is the first-line approach for improving pain, mobility, and function in people with subacromial shoulder pain (Pieters et al., 2020). This recommendation is supported by the most recent Clinical Practice Guideline for rotator cuff-related shoulder pain, published in JOSPT in 2025, which provides strong guidance for exercise-based rehabilitation as the primary conservative pathway (Lafrance et al., 2025).
What type of exercise works best? A 2024 systematic review and meta-analysis found that motor control exercise programmes. Those focused on movement quality, coordination, and scapular control were associated with greater reductions in disability compared to non-specific general exercise in the short and medium term (Minett et al., 2024). However, both approaches produced meaningful improvements, and the most important factor appears to be progressive loading tailored to the individual's capacity and goals.
What about adding manual therapy? A 2024 randomised clinical trial found that adding manual therapy to a resistance exercise programme produced better long-term outcomes compared to exercise alone, with benefits maintained at 52 weeks of follow-up (Michener et al., 2024). This supports the inclusion of hands-on care as an adjunct to exercise — not as a replacement for it.
Is surgery necessary? The current evidence strongly supports conservative management as the primary pathway. The 2025 JOSPT Clinical Practice Guideline explicitly states that subacromial decompression surgery does not provide clinically meaningful benefits over conservative care in people with rotator cuff tendinopathy, and is not recommended as a first-line approach (Lafrance et al., 2025).
How We Approach Shoulder Bursitis at MotionPlus Osteo
At our Te Rapa clinic in Hamilton, a shoulder assessment goes well beyond the shoulder itself. We look at how the neck, upper back, and scapula are contributing to how the shoulder is loading because in most cases, shoulder pain does not exist in isolation.
Depending on clinical findings, a management plan may include:
Hands-on manual therapy — including soft tissue work, joint mobilisation of the shoulder, acromioclavicular joint, and thoracic spine
Progressive exercise prescription — starting with isometric loading and progressing through range as the shoulder responds
Clinical needling — as an adjunctive option for muscle tension and pain modulation around the shoulder girdle
Postural and load management guidance — particularly relevant for tradespeople and desk-based workers
Education — helping you understand what is contributing to your shoulder symptoms and what to expect through recovery
As an ACC registered provider, no GP referral is needed. If your shoulder pain followed a fall, direct impact, or sudden activity change, we may be able to lodge your ACC claim directly at the clinic.
This post is intended for general educational purposes only and does not constitute medical advice. If you are experiencing shoulder pain, please seek an individual assessment from a registered healthcare professional. Craig O'Connor is a registered osteopath with the Osteopathic Council of New Zealand (OCNZ).
References
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Cools, A. M., Declercq, G., Cagnie, B., Cambier, D., & Witvrouw, E. (2014). Internal impingement in the tennis player: rehabilitation guidelines. British Journal of Sports Medicine, 42(3), 165–171. https://doi.org/10.1136/bjsm.2007.036830
Faruqi, T., & Rizvi, T. J. (2023). Subacromial bursitis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541096/
Klatte-Schulz, F., Thiele, K., Scheibel, M., Duda, G., & Wildemann, B. (2022). The morphology of the subacromial and related shoulder bursae: An anatomical and histological study. Journal of Anatomy, 240(5), 941–958. https://doi.org/10.1111/joa.13607
Lafrance, S., Charron, M., Roy, J. S., Dionne, C. E., Frémont, P., MacDermid, J. C., & Doiron-Cadrin, P. (2025). Rotator cuff tendinopathy diagnosis, nonsurgical medical care, and rehabilitation: A clinical practice guideline. Journal of Orthopaedic & Sports Physical Therapy, 55(4), 235–274. https://doi.org/10.2519/jospt.2025.13182
Michener, L. A., Kardouni, J. R., Sousa, C. O., & Ely, J. M. (2024). Adding manual therapy to an exercise program improves long-term patient outcomes over exercise alone in patients with subacromial shoulder pain: A randomized clinical trial. JOSPT Open, 2(1), 29–48. https://doi.org/10.2519/josptopen.2023.1134
Michener, L. A., McClure, P. W., & Karduna, A. R. (2003). Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clinical Biomechanics, 18(5), 369–379. https://doi.org/10.1016/S0268-0033(03)00047-0
Minett, K., Mc Auliffe, S., Mc Creesh, K., O'Donoghue, G., & Lewis, J. (2024). The efficacy of exercise therapy for rotator cuff–related shoulder pain according to the FITT principle: A systematic review with meta-analyses. Journal of Orthopaedic & Sports Physical Therapy, 54(8), 499–512. https://doi.org/10.2519/jospt.2024.12453
Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., & Struyf, F. (2020). An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. Journal of Orthopaedic & Sports Physical Therapy, 50(3), 131–141. https://doi.org/10.2519/jospt.2020.8498
Powell, J. K., Schram, B., & Hing, W. (2024). Is exercise therapy the right treatment for rotator cuff-related shoulder pain? Uncertainties, theory, and practice. Musculoskeletal Care, 22(2), e1879. https://doi.org/10.1002/msc.1879
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Singh, N., Mohamed, N., & Kaur, S. (2022). Subacromial impingement syndrome: A systematic review of existing treatment modalities to newer proprioceptive-based strategies. Cureus, 14(8), e28405. https://doi.org/10.7759/cureus.28405
Zhao, Q., Palani, P., Kassab, N. S., Terzic, M., Olejnik, M., Wang, S., Tomassini-Lopez, Y., Dean, C., & Shellenberger, R. A. (2024). Evidence-based approach to the shoulder examination for subacromial bursitis and rotator cuff tears: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 25(1), 1028. https://doi.org/10.1186/s12891-024-08144-z