In Schuylkill County, shoulder bursitis and rotator cuff tendonitis are different problems but usually occur together. The pain is also very similar because both are an inflammation. Additionally shoulder bursa (fluid filled sacs that help lubricate the tendon motion. Think of bursa as little water ballons.) lie just beneath the rotator cuff tendons. These inflamed tendons (ends of muscles that attach to the bone) can also develop into an impingement syndrome. In an impingement syndrome, a tendon becomes “pinched” between the bones when you lift your arm up, as you do to comb the top of your head.
The shoulder is a very complex joint where several bones, muscles, and ligaments connect the arm to the chest. Impingement syndrome occurs when there is inflammation in the tendons between the top of the arm bone and the tip of the shoulder. Between these bones lie the tendons of the rotator cuff and the bursa that protects these tendons.
Normally, these tendons slide effortlessly within this space. Because of an injury or chronic muscle imbalance of the shoulder muscles, inflammation develops. The inflammation leads to thickening and swelling of the tendons and bursa. The thickening of the tendons and swelling of the bursa usually leads to a narrowing of the joint space for the tendons. Eventually, this space becomes too narrow to accommodate the enlarged tendons and the bursa. Every time the tendons move between the bones in the narrow joint space, they are pinched–this is why the condition is called impingement syndrome.
CAUSES OF SHOULDER BURSITIS
Often an initial injury sets off the process of inflammation. The injury may be very mild but with time, sometimes months to years, the tendons become inflamed because the muscles of the rotator cuff become unbalanced and an abnormality of motion develops. As the muscles and tendons dysfunction over time, there is more and more inflammation and swelling. Eventually the inflammation get so bad there is not enough room for the tendons and bursa to function properly and a pinching starts to occur. The shoulder dysfunction becomes worse and worse until proper muscle balance is restored to the shoulder muscles. On the other hand, if left untreated, the shoulder dysfunction can lead to a torn rotator cuff.
SYMPTOMS OF SHOULDER BURSITIS
Common symptoms include:
- Pain with overhead activities.
- Pain while sleeping at night.
- Pain over the outside of the shoulder and arm.
WHAT KIND OF SPECIALIST SHOULD I SEE?
A non-surgical specialist, like a chiropractic physician, can usually diagnose a shoulder tendonitis, bursitis, or impingement syndrome with a thorough physical exam. Making an accurate diagnosis is necessary for proper treatment. To assess the bone structure of the shoulder X-rays are usually performed. Sometimes an MRI may be considered to make sure there is not a rotator cuff tear.
Tendonitis, bursitis, impingement syndrome, and a rotator cuff tear are different problems, and although they are related, the treatment is different.
WHAT IS THE TREATMENT?
The first step of shoulder bursitis treatment is to decrease the inflammation and swelling.
REST: The rule of thumb is, “If it causes pain, don’t do it!” Reaching for high objects or reaching behind you are the two movements that should be avoided.
OVER THE COUNTER ANTI-INFAMMATORY MEDS: Inflammation can be treated with Motrin, Advil, Aleve, or one of many others. These all fall within the category of “non-steroidal anti-inflammatory medications”. Taken by mouth, these medications help with the inflammation of the tendons and bursa, and help reduce the discomfort.
ICE APPLICATION: Ice can help relieve pain, reduce inflammation, and stimulate blood flow to the injured shoulder.
The second step is to fix the cause, the underlying problem, the shoulder dysfunction.
SHOULDER EXERCISES AND THERAPY: To get to the cause of the problem your chiropractic physician will prescribe therapy to help rid the area of the waste products of the inflammation. Special shoulder stretches and exercise should be given to restore normal muscle balance and proper movement of the shoulder.
MOBILIZATION, MANIPULATION, MASSAGE AND TRIGGER POINT THERAPY: Hands on therapies such as mobilization, manipulation, massage help restore the flexibility and normal motion to the shoulder joints.
KINESIO TAPPING AND SUPPORT: Kinesio tapping is a special type of strapping support that “lifts” the skin away from the injured area to allow for better circulation to the area and waste product drainage of the inflammitory toxins. It can also support weaked muscles and tendons. You may remember that a few of the girl vollyball players had their shoulder tapped with kinesiotape.
If the pain is severe or the problem is slow to respond, a cortisone injection may be necessary. But a word of caution here: It is well known the cortisone injections weaken the muscle tendon and ligaments and pit the joint surfaces. Cortisone may help the pain in the short term but can cause long-term weakness and dysfunction of the shoulder joint.
Severe rotator cuff tears may require surgery if the conservative treatment described above fails.
If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Doctors’ Choice Physical Medicine and Rehab
Dr. David Novatnak
Glee Pascual, Physical Therapist
Pottsville, Schuylkill, PA