Bursa is a sac that contains viscous fluid and functions as a shock absorber. Bursa lies between tendon, ligament and bones. Inflammation of bursa is known as bursitis. Shoulder joint has several bursae, which helps to prevent friction between tendon and bone or ligament and tendon. Most common bursitis observed in shoulder joint is subacromial bursitis. Subacromial bursa is often inflamed following a pinch between rotator cuff and acromion bone and is also known as shoulder joint impingement of rotator cuff. Second most common bursitis of shoulder joint involves sub-deltoid bursa.
Causes Of Shoulder Joint Bursitis (Inflammation)
- Auto Accident– Direct impact following auto accident causes inflammation of bursa.
- Work Accident– Repeated use of shoulder joint at work causes continuous or intermittent friction of bursa, which follows inflammatory reaction of bursa and results in bursitis.
- Sports Injury– Tennis player or baseball player often suffer with shoulder joint bursitis. The cause of inflammation of bursa is repeated trauma or friction of the bursa during repeated shoulder joint movement and rotations.
- Osteoarthritis- Bursitis is often seen in patients suffering with advanced osteoarthritis. Cause of bursitis is traumatic friction of the bursa against osteophytes.
- Rheumatoid Arthritis- Rheumatoid arthritis is an autoimmune disease that causes inflammation of synovial membrane and bursa.
Types of Bursitis
Inflammatory bursitis is more common than calcified bursitis. Inflammatory bursitis is painful and causes stiff joint.
Calcified bursitis often follows inflammatory bursitis. The calcified deposits results in bone formation within bursa. Calcified bursitis is painful condition and causes restricted joint movement.
- Infected bursitis if not treated for prolonged period causes abscess within the bursa.
- Swollen bursa is filled with abscess instead of synovial fluid.
Subarachnoid bursitis results following pinched or pressure caused by coracoacromion ligament and acromion bone. Bursa is often pinched between coracoacromion ligament and acromion bone.
Symptoms and Signs of Shoulder Joint Bursitis (Inflammation)
- Chronic Pain– patient complaints of mild to moderate pain in the beginning, later pain becomes very severe.
- Tender Shoulder Joint– Pressure or touch on top of bursa causes severe pain. Pain is located mostly on the outside of shoulder joint.
- Referred Pain– Pain is often referred or spread to elbow or wrist.
- Shoulder Joint Tenderness– Examination of shoulder joint elicits tender area of shoulder joint on top of the bursa. Patient often complaints of severe pain when lying on side during sleep. Pressure pain often continues even after removal of pressure.
- Painful Shoulder Joint Movement– Patients often complaints of increased intensity of pain when arm is moved at shoulder joint. Abduction or movement of arm above head causes intense pain. Shoulder joint rotation is also extremely painful.
- Shoulder Joint Stiffness– Bursitis if not treated for long time causes shoulder joint stiffness. Patient often is unable to use arm for daily activities like combing or washing hair.
Investigations and Tests to Diagnose Shoulder Joint Bursitis
X-ray of Shoulder Joint
- X-ray does not show bursa.
- X-ray is performed to rule out diseases such as osteoarthritis, dislocation, and fracture of shoulder joint, which may cause similar symptoms.
- Rule out shoulder joint fracture, dislocation and arthritis.
- MRI is also used to visualize inflamed subacromial and subdeltoid bursa.
- Normal bursa on opposite side is compared with inflamed bursa.
CAT scan study is performed to rule out shoulder joint fracture, dislocation and arthritis.
- Ultrasound study is performed to identify inflamed bursa.
- The ultrasound pictures of bursa on symptomatic and non-symptomatic side are compared.
- The inflamed bursa is compared with normal bursa on opposite shoulder joint.
- The fluid within bursa is removed using sterile needle.
- Needle is passed into bursa under ultrasound guidance.
- Fluid is tested for bacteria.
Treatment Of Shoulder Joint Bursitis (Inflammation)
Conservative Treatment Approach for Bursitis of Shoulder-
- Rest is advised while bursitis is treated with anti-inflammatory medications.
- Shoulder joint braces are used for short period.
Passive movement of the joint and stretching exercises are performed under supervision
Moist heat is applied to shoulder joint over inflamed bursa.
- Ice covered with thin plastic is applied over skin. Application is repeated 3 to 4 times a day for 10 to 20 minutes.
- Ice therapy helps to restrict inflammation.
- Ice therapy decreases intensity of the pain.
Physical Therapy (PT) for Treating Shoulder Joint Bursitis (Inflammation)
Physical therapy is performed under supervision. Goal of Physical Therapy for Shoulder Bursitis:
- Improve joint movements
- Prevent joint stiffness
- Prevent muscle weakness and atrophy by passive and active joint movement.
Aim of Physical Therapy (PT) To Treat Bursitis of Shoulder:
- Muscle Stretching
- Muscle Strengthening
- Optimize Joint Mobility
Medications For Treating Shoulder Joint Bursitis
Treatment of Bursitis (Inflammation)
- Side Effects- Stomach Pain, Gastric Ulcer and Bleeding Disorder.
- Most common NSAIDs prescribed are Motrin, Naproxen, Daypro and Celebrex.
Treatment of Pain
- Opioids (Narcotics)-
- Opioids are prescribed when pain is not responding to NSAIDs
- Side Effects- Nausea, Vomiting, Constipation, Dependence and Addiction
- Most Common Opioids (short acting opioids) Prescribed are as Follows –
- Hydrocodone, (Vicodine, Lortab and Norco)
- Oxycodone (OxyIR), Percocet
- Morphine (MS IR)
Treatment of Muscle Spasm-
- Muscle Relaxants-
- Side effects- drowsiness and dizziness.
- Most common muscle relaxants prescribed are as follows- Baclofen, Flexeril, Skelaxin and Robaxin.
Interventional Therapy To Treat Shoulder Joint Bursitis (Inflammation)
Cortisone Injection For Shoulder Joint Bursa
- Inflammation- Cortisone helps to decreases inflammation.
- Analgesics- Cortisone reduces pain.
Surgical Options To Treat Shoulder Joint Bursitis (Inflammation)
Aspiration of Bursa-
- Needle is advanced under ultrasound or CAT scan into bursa.
- Fluid within bursa is aspirated.
Diagnostic Arthroscopy Surgery For Shoulder Bursitis-
- Arthroscopy procedure is performed to view inside of the shoulder joint.
- Arthroscopy helps to identify the inflamed bursa.
- Procedure is performed under sedation or anesthesia.
- Arthroscope is tubular camera, which is connected to television.
- The inside of the joint is magnified and observed on television screen.
Bursectomy: Arthroscopic Excision of Inflamed or Calcified Bursa
- Surgery is performed under anesthesia in surgical center.
- Arthroscope and surgical instrument are inserted in shoulder joint.
- Bursa is excised and removed using surgical equipment such as shaver.
- The excision of bursa is performed while observing the bursa through arthroscope. Surgical equipment like shaver is used to excise the inflamed bursae.
- Surgery is less invasive than open surgery and also causes less tissue trauma.