Shoulder Pain? How to Treat Rotator Cuff Injuries and Bursitis with Effective Rehab

What's really going on in your shoulder?

Over 2 million Americans seek medical help for shoulder pain each year. If you're dealing with that ache or sharp pain in your shoulder, you're not alone. But what's really causing it? Often, it's rotator cuff injury or a condition where the tendons of the shoulder's rotator cuff muscles become inflamed or torn. This is closely related to subacromial bursitis, which is inflammation of the fluid-filled sac (bursa) that cushions the rotator cuff tendons.

Your shoulder is a complex ball-and-socket joint. Four muscles-supraspinatus, the topmost rotator cuff muscle that lifts your arm, infraspinatus, helps rotate your arm outward, teres minor, a small muscle that assists with rotation, and subscapularis, rotates your arm inward-work together to stabilize the glenohumeral joint, the main shoulder joint where the upper arm bone meets the shoulder blade. Above these muscles sits the acromion process, a bony ridge on the shoulder blade. When the subacromial bursa between them gets inflamed, it rubs against the rotator cuff tendons during movement, causing pain.

Common symptoms to watch for

Rotator cuff injuries and bursitis share similar signs. You might notice a painful arc, sharp pain between 60° and 120° of shoulder movement when lifting your arm. Pain often worsens at night, especially if you lie on the affected side. Weakness when reaching behind your back or lifting objects is another red flag. If you feel a dull ache that doesn't go away after rest, it's time to investigate further.

First steps: immediate pain relief

When shoulder pain strikes, start with these simple actions:

• Rest the shoulder for a few days-avoid overhead movements and heavy lifting.
• Apply ice packs for 15-20 minutes, 3-4 times daily, to reduce swelling.
• Take over-the-counter NSAIDs, nonsteroidal anti-inflammatory drugs like ibuprofen (400-600 mg three times daily) to manage pain and inflammation.
• Modify daily activities-like not carrying heavy bags on that side or avoiding sleeping on the affected shoulder.

These steps often ease symptoms within a week. But if pain persists beyond 4-6 weeks, you'll need a more structured plan.

Physical therapy exercises that actually work

Once the acute pain eases, physical therapy becomes key. Here's what experts recommend:

• Pendulum exercises: Lean forward, let the affected arm hang loose. Gently swing it in small circles for 5-10 minutes, three times daily. This helps maintain mobility without straining the shoulder.
• Scapular retractions: Squeeze your shoulder blades together like you're trying to hold a pencil between them. Hold for 5 seconds, repeat 15 times in 3 sets daily. Studies show this speeds up pain relief by 30% compared to focusing only on rotator cuff exercises.
• Resistance band exercises: Use a TheraBand, a flexible resistance band for strengthening to do external rotations. Keep your elbow at your side, rotate your forearm out against the band's resistance. Do 15-20 reps per set, three sets daily. Start with light resistance (30-50% of max effort) to avoid aggravating the injury.

Consistency matters. Patients who do these exercises daily for 8-10 weeks see 68% improvement in pain and function, according to physical therapy clinics.

When injections or surgery might be necessary

If conservative treatments fail after 4-6 weeks, your doctor may suggest corticosteroid injections, ultrasound-guided shots of triamcinolone acetonide (20-40 mg) to reduce inflammation. These provide relief for 65-75% of patients for 4-12 weeks. However, experts limit injections to 2-3 per year due to tendon weakening risks.

Surgery is reserved for cases that don't improve after 3-6 months of non-surgical care. The most common procedure is arthroscopic subacromial decompression, a minimally invasive surgery to remove inflamed bursa tissue and shave down the acromion bone. Modern techniques use 3-4 mm incisions, leading to shorter recovery. But studies show surgery for isolated bursitis without significant tendon tears offers little advantage over physical therapy alone. A 2022 study found no significant difference in shoulder function scores between surgical and non-surgical groups at 12 months.

Long-term prevention tips

To avoid future shoulder issues:

• Strengthen scapular muscles daily: Focus on exercises like scapular retractions and rows. Strong shoulder blades prevent impingement.
• Avoid repetitive overhead motions: Take breaks every hour if your job involves lifting or reaching above shoulder height.
• Use proper lifting technique: Bend at the knees, keep objects close to your body, and avoid twisting.
• Listen to your body: Stop activity if pain exceeds a 5 on a 0-10 scale. Pushing through pain often worsens injuries.

People in high-risk jobs-like construction workers or athletes-have a 32-45% higher chance of shoulder problems. Consistent prevention makes all the difference.

Frequently Asked Questions