Shoulder bursitis and rotator cuff tendonitis are different ways of
saying there is inflammation of a particular area within the shoulder
joint that is causing a common set of symptoms.The proper terminology for these symptoms is impingement syndrome.
Overview
Impingement syndrome occurs when there is inflammation of the rotator
cuff tendons and the bursa that surrounds these tendons. There is a
difference between tendonitis and bursitis, but there is a combination
of these problems in most cases of impingement syndrome.
The shoulder is a complex joint where several bones, muscles, and
ligaments connect the upper extremity to the chest. Impingement syndrome
occurs when there is inflammation between the top of the humerus (arm
bone) and the acromion (tip of the shoulder blade). Between these bones
are the tendons of the rotator cuff, and the bursa that protects these
tendons. Normally, these tendons slide effortlessly within this
space—called the subacromial space.
Causes
Impingement syndrome is a descriptive term for the pinching of the
tendons and bursa of the rotator cuff between the bones. In many
individuals with this problem, the shape of their bones is such that
they have less space than others. Therefore, small thickenings of the
tendons or bursa can cause symptoms. Eventually, this space becomes too
narrow to accommodate the tendons and the bursa, and every time these
structures move between the bones they are pinched.
Often there is an initial injury that sets off the process of
inflammation. After that, the problem can be self-exacerbating.
Inflammation causes a thickening of the tendons and bursa. The
thickening then takes up more space, and therefore the tendons and bursa
become are pinched even more. This causes more inflammation, and more
thickening of the tendons and bursa, and so on.
Symptoms
Common signs of shoulder bursitis include:
·Pain with overhead activities (arm above head height)
·Pain while sleeping at night
·Pain over the outside of the shoulder/upper arm
Diagnosis
Making the diagnosis of impingement syndrome can usually be accomplished
with a thorough physical exam. It is important to be examined by a
doctor familiar with different causes of shoulder pain, as other
problems can have similar symptoms. Making an accurate diagnosis is
necessary for proper treatment. X-rays are usually performed to assess
the bony anatomy of the shoulder. An MRI may be considered to ensure
there is no sign of a rotator cuff tear.
Impingement syndrome and a rotator cuff tear are different problems, and
although they are related, the treatment is different. Rotator cuff
tears are more likely to require surgical intervention, although the
truth is that the majority of rotator cuff tears can also be managed
with noninvasive treatments.
Treatment
Most patients with shoulder bursitis can find relief with some simple,
non-surgical treatments.3 Only in rare circumstances is surgery
necessary for the treatment of shoulder bursitis. Specific treatments
may differ depending on the preferences of the patients, their
expectations, and their response to treatment.
Non-Surgical Treatment
Many people find relief with resting from specific non-surgical
treatments that include activities, physical therapy, and
anti-inflammatory medications. One of the most common uses of a
cortisone injection is for the treatment of impingement syndrome.3 If
you want to pursue any of these treatments for your impingement
syndrome, it is worthwhile to discuss with your doctor. If the
treatments have been tried for at least three to six months without
improvement in symptoms, a surgical procedure called a subacromial
decompression might be considered.
Surgical Treatment
Subacromial decompression is an arthroscopic surgery performed using
instruments inserted through small incisions.2 Depending on the location
of the inflammation and the extent of work that needs to be done,
usually two to four small (1 centimeter) incisions are made. A small
tube called a cannula is inserted into each incision to allow easy
passage of instruments in and out of the shoulder without damaging the
surrounding tissues. One of the instruments inserted into the shoulder
is a video camera about the size of a pencil. Another instrument called a
shaver is inserted through another cannula. The shaver is used to
remove the inflamed bursa. Once the bursa is removed, the rotator cuff
is inspected to look for any signs of a tear.
The bone above the rotator cuff (the point of the shoulder) is called
the acromion. Many people with bursitis of the shoulder have a bone spur
that forms on the undersurface of the acromion. Depending on the bone
of the acromion, a burr may be used to remove the spur to create more
space for the rotator cuff tendons. The benefit of removing the bone
spur is a subject of debate among orthopedic surgeons. Some surgeons
believe the spur is a major cause of inflammation by taking up space
around the rotator cuff tendons, while others contend that removing the
bone spur has never been shown to improve the results of patients who
have this surgery.
People who undergo surgery are placed in a shoulder sling following
subacromial decompression, but they can begin shoulder motion quickly.
Unlike surgery for a rotator cuff tear, there is no need for a period of
restricted motion to allow for tendon healing. In cases of an isolated
subacromial decompression, patients can begin gentle motion immediately
after surgery. Strengthening can begin within a few weeks, and sports
can resume after the swelling has subsided.
Because a subacromial decompression is often a part of another surgical
procedure ,such as a rotator cuff repair or labral repair surgery, the
rehab may be very different under these circumstances. Therefore, any
patient should discuss their rehab progression with their own surgeon.
Complications after subacromial decompression are uncommon but can
occur.2 The most common problems are pain and stiffness that usually
resolve with physical therapy and time. However, there are more serious
complications including infection, nerve injury, and cartilage damage,
all of which can cause long-term problems. It is important to take steps
to prevent these complications to ensure the best possible result of
surgery.
Kind Advice
Impingement syndrome is the medical name given to inflammation of the
rotator cuff tendons and the bursa that surrounds these tendons. This
common condition can cause pain in the shoulder joint, especially when
lifting the arm up overhead. Fortunately, simple treatments are often
effective at controlling the inflammation associated with bursitis or
tendinitis. If these simple treatments are not adequate to control your
symptoms, there are invasive surgical options that can be considered.
Generally, these are only considered when the simpler treatments have
been exhausted and are no longer effective. While surgical treatment can
be effective in these situations there is postoperative rehabilitation
and potential complications from surgery that can occur. For that
reason, your orthopedist will likely try the simple treatments first to
see if they are effective.
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