When shoulder bursitis or tendonitis stem from injury or overuse, initial treatment includes rest and other remedies to relieve inflammation. In cases of septic bursitis, in which the bursa is infected, antibiotics also must be used to prevent the spread of infection.
Nonsurgical treatments are almost always recommended first. A person with shoulder bursitis may be advised to try:
Avoid activities that will aggravate and inflame the shoulder bursa, such as throwing, lifting, pushing, and pulling.
Pain-relieving creams, sprays, gels and patches and are applied directly to the skin over the painful joint. A topical medication may treat the inflammation that causes pain, distract from the pain, or numb nerve endings to reduce or eliminate pain.
See Topical Pain Relief for Arthritis
Topical medications may be a good choice for people who want to minimize gastrointestinal side effects that oral medications sometimes cause. However, side effects are still possible. Patients should always discuss new medications with their doctor or pharmacist and read drug labels and instructions.
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A doctor may prescribe physical therapy to stretch or strengthen shoulder muscles and improve posture, which may help treat the current bursitis and tendonitis and ward off future problems.
See Shoulder Exercises for Arthritis
Non-steroidal anti-inflammatory drugs, or NSAIDs
Oral anti-inflammatory medications, such as aspirin, ibuprofen (e.g. Advil), naproxen (e.g. Aleve), and cox-2 inhibitors (e.g. Celebrex) can reduce swelling and inflammation and relieve pain associated with shoulder bursitis and tendonitis.
Aspiration to drain the bursa
Even when inflamed, the subacromial bursa usually does not swell significantly. However, in some cases a doctor may recommend draining excess fluid from the bursa using a needle and syringe (called aspiration). A cortisone injection may be done at the same time.
See What Is Arthrocentesis (Joint Aspiration)?
Symptoms that are not successfully treated with rest, NSAIDs, and/or physical therapy possibly may be relieved with corticosteroid injections. These injections carry potential side effects and may weaken the nearby tendons, 1 Kompel AJ, Roemer FW, Murakami AM, et al. Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Radiology. October 15, 2019. DOI: 10.1148/radiol.2019190341 , 2 Brook EM, Hu CH, Kingston KA, Matzkin EG. Corticosteroid Injections: A Review of Sex-Related Side Effects. Orthopedics. 2017 Mar 1;40(2):e211-e215. doi: 10.3928/01477447-20161116-07. Epub 2016 Nov 23. Review. PubMed PMID: 27874912. so they should be used sparingly and only after rest, physical therapy, and medications fail. 3 Codsi MJ. The painful shoulder: when to inject and when to refer. Cleve Clin J Med. 2007 Jul;74(7):473-4, 477-8, 480-2 passim. Review. PubMed PMID: 17682625.
See Cortisone Injections (Steroid Injections)
Septic subacromial bursitis requires treatment with antibiotics. The choice of antibiotic may be influenced by what microorganism is causing the infection (often staphylococcus aureus). Most people with septic bursitis are effectively treated with oral antibiotics. More challenging cases may require hospitalization and antibiotics delivered intravenously.
It is important to wait until all symptoms have resolved before resuming regular activities. Returning to activities that cause friction or stress on the shoulder bursa or tendons before they are healed will likely cause symptoms to flare up again.
If shoulder bursitis is chronic an does not respond to treatment, surgery may be recommended.