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I have shoulder pain – could this be shoulder bursitis?

Shoulder pain may be caused by bursitisShoulder bursitis could certainly be the cause of your pain. It is one of the more common causes of shoulder pain that I see and treat on a daily basis Waterfall Hospital in Waterfall/Midrand and Morningside Mediclinic in Sandton. An accurate diagnosis can be made through examination and simple, non-invasive investigations. The good news is that it is treatable and, in many instances, does not require surgery…

What is shoulder bursitis?

A bursa is essentially small sack or pocket of tissue. It is found in various places of the body. They are found where there is movement of skin over bone or tendon over bone. A bursa acts like small cushion and assists with gliding movements. In the shoulder, a bursa is found between the tendons which elevate the arm below and the bone which forms the roof of the shoulder joint above. This is called the subacromial bursa.

If the bursa becomes inflamed it may cause shoulder pain. Sometimes this can be severe enough to prevent sleep at night. The location of the pain is usually just to the side of the top of the shoulder. It often radiates down the side of the arm. When you try and lift your arm the bursa and underlying tendon can get pinched by the acromion above. This results in a painful arc of movement. This is called shoulder impingement.

What causes shoulder bursitis?

Shoulder bursitis is commonly caused by overuse. This may be due to repetitive overhead activities. An injury or a fall may also cause the problem. Anatomical differences in the shape of the bone plays a key role in determining the development of bursitis. Infection, gout and certain medical conditions such as diabetes and thyroid dysfunction can also play a role.

How do you diagnose shoulder bursitis?

Shoulder pain may be caused by bursitisOften shoulder bursitis can be diagnosed clinically. A shoulder surgeon like myself will examine your shoulder completely. The diagnosis is suggested if you have a painful arc when lifting the arm or if you have signs of impingement. To test for impingement the arm is placed in various positions of elevation and rotation. The inflamed bursa will be “pinched” against the acromion and cause pain.

X-ray for shoulder bursitis

And x-ray is invariably taken. The reason for the x-ray is twofold.

  1. The first is to exclude other causes of pain is such as osteoarthritis of the shoulder / acromioclavicular joint (ACJ), or calcific tendinitis.
  2. The second reason for the x-ray is to analyse the shape of the bones in the shoulder. The acromion, which can be thought of as the roof, is located just above the bursa and tendons. Some individuals have a curvature to this bone and in some people the curvature is quite severe. It can end in a sharp point or hook at the front of the shoulder. Shoulder bursitis can take longer to resolve in these people and there is a higher likelihood that surgery may be required.

Ultrasound for shoulder bursitis

An ultrasound scan is another very useful investigation. An ultrasound scan is a non-invasive and inexpensive scan which makes use of sound waves to form a picture of the various tissues in the shoulder. A large, fluid-filled inflamed bursa, is usually easily identifiable. Sometimes impingement can be seen during the ultrasound scan. The ultrasonographer rotates the arm and looks for areas where the bone is pinching the underlying tendon and bursa.

Another reason to have an ultrasound scan is to rule out a tear of the tendons which elevate and rotate the shoulder (the rotator cuff tendons). If a rotator cuff tear is found during the scan more urgent treatment may be required. (see: Two signs that may mean you have a rotator cuff tear)

How do you treat shoulder bursitis?

Shoulder bursitis may require surgeryThe first thing to do is to rest the shoulder adequately. You should stop any activities which are exacerbating the pain. Icing may help occasionally and sometimes anti-inflammatories are prescribed. Physiotherapy may be of use to improve posture and reduce pressure on the inflamed bursa.

As a shoulder surgeon, patients normally present to me for further treatment options once these measures have failed. An injection of cortisone into the inflamed bursa is very often successful. This is often the only treatment required. Cortisone is a steroid medication which acts as a strong, localised anti-inflammatory. Occasionally it may take two or three injections for the bursitis to settle completely.

Surgery for shoulder bursitis

Surgery for shoulder bursitis is considered when these other treatment options have not been successful. As a shoulder surgeon I perform the procedure arthroscopically (minimally invasive or keyhole surgery).

Acromioplasty for shoulder bursitis

Arthroscopic picture of an acromioplasty

The shoulder operation is performed as a day case procedure which means that you do not have to sleep in hospital. A thorough inspection is made of the shoulder joint to rule out any other abnormalities. The inflamed bursa is then removed. In most instances it is found that the overlying bone (acromion) is pinching or rubbing against the bursa and tendon. This happens usually in the front and side areas. The portion of bone in these parts of the acromion is smoothed off and made flat. This procedure is called an acromioplasty and is performed to increase the space between the bone and the underlying tendon. Although the bursa is removed a new one will eventually grow back in its place.

In summary

Shoulder bursitis is a common cause of shoulder pain. Therefore, if you think you may have bursitis it is recommended that you see a shoulder surgeon to discuss further treatment options. You may need investigations if the pain has lasted more than a couple of weeks and initial treatments such as anti-inflammatories have not helped.

Yours in good health,

Dr Warren Matthee

MB BCh (Wits), MRCS (England), MMed (Ortho Surg), FC Orth (SA)

Orthopaedic Surgeon

(011) 304 6784

About the author…

I am an orthopaedic surgeon with a special interest in sports injuries and minimally invasive (arthroscopic) surgery of the knee and shoulder. I treat patients at Waterfall Hospital in Waterfall/Midrand and Morningside Mediclinic in Sandton. Besides these, I also treat patients from other areas as well, including Rosebank, Sunninghill and Fourways.

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    Shoulder bursitis pain can be worsened with reaching above shoulder height