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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.’ 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 in most cases of impingement syndrome there is a combination of these problems.
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). Between these bones lies the tendons of the rotator cuff, and the bursa that protects these tendons.
Normally, these tendons slide effortlessly within this space. In some people this space becomes too narrow for normal motion, and the tendons and bursa become inflamed. Inflammation leads to thickening of the tendons and bursa, and contributes to the loss of space in this location. 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–this is why the condition is called impingement syndrome.
Impingement syndrome is a descriptive term of pinching of the tendons and bursa of the rotator cuff between 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.
Often there is an initial injury that sets off the process of inflammation. Thereafter, the problem can be self-exacerbating. Once there is an initial injury, the tendons and bursa become inflamed. This inflammation causes a thickening of these structures. The thickening then takes up more space, and therefore the tendons and bursa become are pinched upon even more. This causes more inflammation, and more thickening of the tendons and bursa, and so on.
Common symptoms include:
Making the diagnosis of impingement syndrome can usually be accomplished with a thorough physical exam. It is important to be examined by an individual familiar with different causes of shoulder pain, as there are other problems that 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.
Bursitis can be treated in a number of ways, including:
Dr. Woodworth can also prescribe drugs to reduce the inflammation. Corticosteroids, also known simply as “steroids,” are often used because they work quickly to decrease the inflammation and pain. Steroids can be injected directly at the site of injury. Injections are often, but not always, effective and can be repeated . However, multiple injections in a several month period are usually avoided due to potential side effects from the injections and the possibility of masking problems that need to be treated differently.
Physical therapy is another treatment option that is often used. This includes range-of-motion exercises and splinting (thumb, forearm, or bands).
Surgery, although rarely needed, may be an option when bursitis does not respond to the other treatment options.
Woodworth Orthopedics and Sports Medicine will help you decide how to best treat shoulder bursitis. Call Dr. Woodworth today at (702) 545-6194 for an appointment.
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