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Shoulder bursitis is a frustrating condition that causes pain when lifting your arm, reaching overhead, or even lying on your side. In this blog, we’ll explain what shoulder bursitis is, whether a cortisone injection is the right choice, why exercise therapy is crucial, why a combination approach often works best, and how ultrasound imaging plays a role in accurate diagnosis. What is Shoulder Bursitis? As with many joints in the body, even the Acromion Clavicular Joint (ACJ) is characterised by the presence of a bursa known as the subacromial bursa, which is a fluid-filled sac that cushions the shoulder tendons, specifically the supraspinatus tendon, but partially also other cuff rotator tendons, as per the deltoid tendon. When the bursa becomes inflamed and swells, it can lead to pain with overhead movements, night pain, and reduced shoulder strength. This presentation is often linked to rotator cuff–related shoulder pain, which is why treatment usually targets both the inflamed bursa and the surrounding muscles. What Can Cause It? Shoulder bursitis is often caused by repetitive movement with the arm above the head. This type of motion, indeed, is quite common in certain sports (basketball, cricket, volleyball…) but even in factory settings and other types of work environments. It is not gender predominant, but it is more common for older patients, due to the possibility of being exposed to those types of movement for a longer time. The compression of the bursa, in the longer term, is what leads the bursa to swell. The compression may happen while the space between the acromion and the humeral head reduces while the arm is moving, like in flexion and abduction movements. We also have to say that, given the anatomical differences that characterise each individual, someone could be more prone to this type of injury than others, given a wider or thinner space between the above-mentioned structures. Common Shoulder Bursitis Symptoms As per many conditions, even shoulder bursitis’ symptoms can vary from person to person. Here is a list of the most and least common ones: Pain on the outside or top of the shoulder; Pain that worsens when lifting the arm overhead or reaching behind the back; Sharp pain when lying on the affected shoulder (often disturbing sleep); Aching pain at rest or after activity; Shoulder stiffness or reduced range of motion; Weakness when lifting or rotating the arm; Tenderness around the shoulder joint when touched. Occasional swelling or warmth around the shoulder (less common). What treatment Options Are Out There for Shoulder Bursitis? In terms of treatment options, we are looking at mainly two approaches, and as science has proven so far, the best approach is the combination of both. Cortisone injection Manual therapy Should I Get a Cortisone Injection? Yes (sometimes). Cortisone (corticosteroid) injections can provide fast pain relief, especially if pain is stopping you from sleeping or moving. Considering rest and movement as activities that we can live without, it is important to find a quick therapy that can restore those activities. On the other hand, the relief is usually short-term. In fact, without strengthening exercise, pain can return. Injections also carry small risks such as: Temporary pain flare-ups Skin thinning A rise in blood sugar for people with diabetes Why Exercise Therapy is Essential If cortisone injections help with the pain, exercises are what fix the problem long-term. Research consistently shows that shoulder-strengthening programs improve pain, function, and quality of life over weeks to months. At my Fitzroy North clinic, as a Clinical Myotherapist, I can guide you through: Rotator cuff strengthening to support the joint Scapular control exercises for better shoulder mechanics Gradual load progression so your shoulder adapts safely The time frame of healing can range between 6 and 8 weeks, with continued strength gains over 3 months. During this time, it is important to maintain consistency with the exercises, 3 times a week, increase the load as necessary, and allow the body to rest when needed Why the Best Option is Both: Injection + Exercise As mentioned earlier, cortisone injection is a quick fix to restore the shoulder functionality and reduce pain drastically, but it works only in the short term, and most people receiving this form of treatment would experience pain again within a few weeks post-injection. Therefore, to have a better chance of settling the presentation in the long term, it is suggested to combine cortisone injection with a structured exercise program, which would result in better outcomes than either treatment alone. Here is a breakdown: Injection reduces pain → lets you move and exercise. Exercise builds long-term strength and function → prevents flare-ups. Together, they deliver both short-term relief and long-term recovery. This is the approach I often recommend at Melbourne Massage & Treatment, Myotherapy Clinic, in Fitzroy North.  And for those who are keen to restore their shoulder functionality via exercises, I do offer a treatment plan specific to the Fitness Class. This way, you get to have a tailored program for your strength activity at a discount price. If you think this would work for you, book your next appointment now via the booking page. The Role of Ultrasound in Diagnosing Shoulder Bursitis Ultrasound scans for shoulder bursitis are a reliable method for confirming bursitis and guiding injections. Along with an ultrasound scan, it is not only possible to check the status of the bursa, such as thickened or inflamed, but it is also possible to see if another structure (like a rotator cuff tendon) is the source of pain. Lastly, studies also show that ultrasound-guided injections are more accurate than “blind” injections. Shoulder Bursitis Treatment at Fitzroy North Clinic At Melbourne Massage & Treatment, I combine hands-on myotherapy, targeted exercise programs, and collaboration with GPs to address a presentation like shoulder bursitis. Our approach is: Thorough assessment → sometimes supported with ultrasound imaging (for this, you will need a GP’s referral). Exercise rehab → first-line, tailored to your pain and goals – Starting with Isometric exercises, then step into concentric with load. […]