Shoulder bursitis is a painful condition where the bursa (normal lining) of the shoulder becomes inflamed. The symptoms of bursitis include aching in shoulder are that may radiate towards the neck and down to the elbow. Lying on the shoulder at night may be especially difficult. Movement upward may result in pain as the arm is straight out from the body and trying to reach into a hip pocket may be very painful.
Once of the most common causes of bursitis is a condition called shoulder impingement. Shoulder impingement occurs when the rotator cuff tendon and the bursa are pinched between the humerus (arm bone) and acromion (part of the wing bone). Some degree of impingement occurs during normal activity, but constant overhead use of the arm may result in irritation of the bursa and tendons. This irritation leads to painful inflammation of the shoulder, which can be disabling. Excessive wear from shoulder impingement can also result in rotator cuff tears with resulting shoulder weakness, decreased motion, and pain.
Any condition which reduces the amount of space between the acromion and the humeral head can increase the likelihood of developing bursitis. Bone spurs from the nearby acromioclavicular joint or variation in the anatomy of the acromion are fairly common. Both of these conditions can be identified with proper examinations.
The diagnosis of impingement and bursitis is usually made on the basis of the patient’s history and physical examination. X-rays may confirm the presence of an abnormal acromion, or degeneration and spur formation of the acromioclavicular joint. In addition, an MRI can may be performed if an associated rotator cuff tear is suspected. In some cases, injection of a local anesthetic into the bursa can be used to make sure that the pain is in fact coming from the shoulder, and not radiating from the neck.
Initial treatment for bursitis from impingement usually includes rest, a mild anti-inflammatory medication, and a prescribed course of gentle physical therapy. If these measures fail to improve the pain, and injection of cortisone into the bursa may be beneficial. Cortisone is a potent anti-inflammatory medication that specifically targets the affected joint and can help bring the discomfort under control.
If all conservative measures fail, surgery may be required to reduce the symptoms. Surgery for impingement usually begins by removing a portion of the acromion. Any spurs that appear to be rubbing on the bursa and tendons are removed and a ligament called the coracoacromial ligament is cut as well. This gives the tendons room to move without rubbing, therapy decreasing the pain and inflammation in the bursa and tendons.
In most cases, this entire procedure can be done arthroscopically allowing you to go home the same day. A safe post-operative rehabilitation program can then be initiated to help restore painless shoulder function.
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