Bursitis is an inflammation of the sac that generates the fluid protecting muscles during movement. Shoulder bursitis is a common problem for both men and women. Many of the muscles around the shoulder joint have bursa that lubricate and cushion the muscles so they can function without friction and pain.
What is a Bursa?
A bursa is a sac that is located near joints and is filled with a slippery viscous fluid. This fluid acts as a lubricant so the tendons of muscles can glide smoothly during movement. There are several bursa around the shoulder joint, but four stand out as being the most clinically significant.The four bursa in the shoulder are:
- Subacromial bursa – located on the anterior part of the shoulder near where the clavicle or collar bone joins the shoulder joint. Its function is to lubricate the acromion of the scapula and the rotator cuff tendons. This bursa is frequently involved with activities such as throwing overhand (sometimes called “little leaguer’s shoulder”), swimming or working in an occupation where the arm(s) are above shoulder height and outstretched.
- Subscapular bursa – located beneath the scapula on the back side of the shoulder. This bursa can contribute to neck, shoulder and upper arm pain when inflamed. This bursa can be irritated with the same movements and activities as the subacromial bursa. Overuse and poor posture are major factors in the onset of symptoms.
- Subdeltoid bursa – located under the large deltoid muscle on the lateral aspect of the shoulder joint. When inflamed it can be very painful when trying to lift the arm straight out to the side. This bursa along with the subacromial are the most commonly involved bursa in the shoulder. Subdeltoid bursitis can occur from trauma or impact, repetitive strain and the impingement syndrome from a possible bone spur or tendon swelling.
- Subcoracoid bursa – located below the coracoid process of the scapula and between the shoulder joint capsule. Inflammatory arthritis, crystal deposition disease (gout or other crystalline conditions that can be seen on x-ray) and shoulder impingement can contribute to bursitis in this area.
Common Causes of Shoulder Bursitis
The cause of bursitis may be simple or complex. Taking a history and performing an examination are necessary to help the doctor determine the course of treatment. The common causes of shoulder bursitis are:
- Direct trauma or acute injury – Falling on your shoulder or a direct blow from an object over the bursa can contribute to bursitis. A torn or frayed rotator cuff tendon is capable of causing an irritation to the bursa.
- Overuse syndrome – Repetition of overhead work, sport or other activities of daily living can stress the shoulder over a period of time.
- Bone spur – A bone spur on the underside of the top or roof of the shoulder joint may irritate the bursa and result in an impingement syndrome.
- Calcium deposits – hydroxyapatite deposition disease (HADD) is released from bone and results in an acute synovitis or inflammation of tissue around the shoulder joint. In many cases, this finding is present in patients with chronic arthritis. If this is left unchecked, joint destruction and instability may occur. HADD is more common in the older patient.
- Infection – Care must be taken if an open wound occurs near a shoulder bursa. The infection may originate from other areas in the body, but most often it begins near the shoulder wound.
Symptoms of Shoulder Bursitis
Bursitis can be a rapidly developing condition that occurs over just a few days. Symptoms that accompany shoulder bursitis are:
- Pain with shoulder movement
- Increased pain at night – lying on the shoulder is very painful and interferes with sleep.
- Swelling, redness and warmth over the involved bursa
- Dull deep ache in the shoulder
Rotator cuff injury has a similar presentation. The physical examination helps the doctor to determine the cause of your shoulder pain.
Treatment of Shoulder Bursitis
The goal of treatment is to reduce and eliminate the pain and restore joint function. The initial treatment is the same for bursitis, rotator cuff injury and impingement syndrome. Chiropractic treatment may include:
- Resting the arm and shoulder at the onset of symptoms
- Ice instructions to help reduce inflammation
- Modalities such as ultrasound and other supportive office therapy treatment
- Myofascial trigger point therapy to the supporting muscles
- Specific exercises for the shoulder and supporting muscles
- Gentle mobilization of the shoulder joint once the acute pain has subsided to help restore movement
It’s difficult to determine exactly how long it will take for recovery. Variables include duration of the symptoms and how quickly the treatment begins. Continuing to do the same activities that created the problem is not conducive for quick results. Constant use of the shoulder and ignoring the pain will continue the bursa and tendon inflammation. These activities can reduce or delay the recovery. It’s possible the bursitis can resolve within a couple of weeks if all instructions are followed.
The doctors at Coon Rapids Chiropractic Office will work to assist you in the care and treatment of your shoulder bursitis.