Shoulder Bursitis

Shoulder Pain from Rotator Cuff Tendonitis

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Many people seek help from their orthopedist for shoulder pain, and a common diagnosis given is 'shoulder bursitis,' or 'rotator cuff tendonitis.' These words are often used interchangeably, but they can cause confusion for people who wonder which of these conditions they may have or if they are actually the same condition.

Tendonitis or Bursitis?

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.

Where Is The Problem?

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. In some people this space becomes too narrow for normal tendon motion, and the tendons and bursa become inflamed.

Inflammation leads to thickening of the tendons and bursa, and contributes to the lack of adequate room in the subacromial space. 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.

Causes of Shoulder Bursitis

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.

Symptoms of Shoulder Bursitis

Common symptoms 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

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.

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 of Shoulder Bursitis

Most patients with shoulder bursitis can find relief with some simple, non-surgical treatments.  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. Many people find relief with resting from specific activities, physical therapy, and anti-inflammatory medications. One of the most common uses of an injected anti-inflammatory, called a cortisone shot, is for the treatment of impingement syndrome. If you want to pursue any of these treatments for your impingement syndrome, it is worthwhile to discuss with your doctor.

Sources:

Aaron DL, et al. "Four Common Types of Bursitis: Diagnosis and Management" J Am Acad Orthop Surg June 2011 ; 19:359-367.

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