Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.
Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. The result is a condition known as subacromial bursitis. Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as combing your hair or getting dressed, may become difficult.
A tendon is a cord that connects muscle to bone. Most tendinitis is a result of a wearing down of the tendon that occurs slowly over time.
Generally, tendinitis is one of two types:
- Acute. Excessive ball throwing or other overhead activities during work or sport can lead to acute tendinitis.
- Chronic. Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.
The most commonly affected tendons in the shoulder are the four rotator cuff tendons and one of the biceps tendons. The rotator cuff is made up of four small muscles and their tendons that cover the head of your upper arm bone and keep it in the shoulder socket. Your rotator cuff helps provide shoulder motion and stability.
Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the acromion rubs, or "impinges" on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement. Over time, severe impingement can even lead to a rotator cuff tear.
In the case of an acute injury causing intense pain, seek medical care as soon as possible. If the pain is less severe, it may be safe to rest a few days to see if time will resolve the problem. If symptoms persist, see Dr. Wilson.
Dr. Wilson will conduct a thorough evaluation in order to determine the cause of your shoulder pain and provide you with treatment options.
The first step in the evaluation is a thorough medical history. Dr. Wilson will ask how and when the pain started, whether it has occurred before and how it was treated, and other questions to help determine both your general health and the possible causes of your shoulder problem. Because most shoulder conditions are aggravated by specific activities, and relieved by specific activities, a medical history can be a valuable tool in finding the source of your pain.
A comprehensive examination will be required to find the causes of your shoulder pain. He will look for physical abnormalities, swelling, deformity or muscle weakness, and check for tender areas. He will observe your shoulder range of motion and strength.
Dr. Wilson may order specific tests to help identify the cause of your pain and any other problems.
X-rays. These pictures will show any injuries to the bones that make up your shoulder joint.
Magnetic resonance imaging (MRI). MRI studies create better pictures of soft tissues. It may help identify injuries to the ligaments and tendons surrounding your shoulder joint. Dr. Wilson’s office has an MRI machine on site which adds to your convenience.
Treatment generally involves rest, altering your activities, and physical therapy to help you improve shoulder strength and flexibility. Common sense solutions such as avoiding overexertion or overdoing activities in which you normally do not participate can help to prevent shoulder pain.
Dr. Wilson may prescribe medication to reduce inflammation and pain. If medication is prescribed to relieve pain, it should be taken only as directed. He may also recommend injections of numbing medicines or steroids to relieve pain.
Surgery may be required to resolve some shoulder problems; however, 80% of patients with shoulder impingement or bursitis will respond to simple treatment methods such as altering activities, rest, exercise, injections and medication.
Surgery for impingement is all-arthroscopic and involves removing bone spurs, the inflamed bursa and trimming torn or frayed tissue. Immobilization in a sling is only required for a week or two and therapy is usually started immediately to regain motion and strength as quickly as possible.