Dr. Rocco Bassora, Sports Medicine Surgeon, walks us through the anatomy of the shoulder, how shoulder bursitis can affect it, and how to treat this painful condition.
‘What is shoulder bursitis’ is a commonly asked question, and shoulder bursitis is a very common cause of shoulder pain. Learn about basic shoulder anatomy below to understand this condition more:
The shoulder is a ball and socket joint that is inherently unstable. There are very small muscles - rotator cuff muscles - that attach to the ball, in addition to surrounding ligamentous tissues that encompass the joint. These muscles and tissues help center and stabilize the ball - humeral head - within the socket, or glenoid.
Atop these muscles lies a bursa (from the Latin word “purse”), which is a fluid filled sac that serves to lubricate and nourish the underlying muscles in order to help minimize friction between tissues. Sometimes the space in which the bursa resides may decrease with certain positions of the shoulder, causing compression of this structure. When this occurs, the bursa may become irritated and swollen, ultimately leading to inflammation and pain.
Patients typically present with shoulder pain in the overhead position, pain with reaching out, and often have complaints of night pain when lying on the affected side. The pain is usually located along the side of the arm, as opposed to the uppermost portion of the shoulder, due to referred pain which radiates down from where the bursa is located.
Upon presentation and physical examination, pain is often elicited when placing the upper extremity in the overhead position. Pain is very rarely elicited with direct palpation along the side of the shoulder. Radiographic images are often taken in the office and can reveal small calcium deposits within the bursa and tendons.
Shoulder Pain Treatment
Treatment typically consists of ice to the shoulder for 20 minutes nightly, anti-inflammatory medications and a simple home exercise program for rehabilitation. For patients who are resistant to this form of treatment, a cortisone injection which is placed directly into the bursa often helps to alleviate inflammation and pain. In addition, formal physical therapy may also help symptomatic patients.
If conservative management in the form of anti-inflammatory medications, physical therapy and injections fail for more than 6 months, there may be a role for a minimally invasive arthroscopic procedure in which the bursa sac is removed and the space in which it resides is widened. The majority of patients do not require this procedure and often respond favorably to conservative management.
Shoulder Bursitis vs. Arthritis and Rotator Cuff Tears
Patients with shoulder bursitis and those who have sustained a rotator cuff tendon tear often present with similar symptoms. The difference lies in the physical examination by an experienced orthopaedist. Oftentimes, patients who have sustained rotator cuff tendon tears will have weakness with resisted external rotation and resisted forward flexion, a finding which is absent in patients with shoulder bursitis.
Likewise, patients with shoulder arthritis typically present with symptoms suggestive of shoulder bursitis, but often have limited range of motion and grinding on examination with good strength. The pain is also located more along the front of the shoulder, deep within the joint, as opposed to the side of the arm, which is typically seen with shoulder bursitis.
It is important for the clinician to delineate between shoulder bursitis and rotator cuff tendon tears, as the latter may require surgical intervention. On the flip side, shoulder arthritis can often be treated conservatively. In those patients who have failed conservative management for a prolonged period of time, shoulder replacement surgery often provides significant pain relief as well as improvement in range of motion.
If you’re dealing with shoulder pain, keep the following overview in mind:
- Shoulder bursitis is a common cause of shoulder pain
- Patients present with pain along the side of the arm, difficulty with overhead activities, pain with reaching out and night pain when lying on the affected shoulder.
- Shoulder bursitis can often be treated conservatively with anti-inflammatory medications, a home exercise program/physical therapy, and ice. Stubborn cases can be treated with a steroid injection placed directly into the bursa sac.
- A minimally invasive arthroscopic procedure can be performed in patients who have failed conservative management for greater than 6 months.
- It is important for the clinician to delineate between shoulder bursitis and rotator cuff tendon tears as the latter may require surgical intervention
- Patients who present with shoulder arthritis typically have pain which is located more along the front of the shoulder, and often have limited range of motion. In addition, they often experience a "grinding "sensation with shoulder movement, which is evident on examination.
- Shoulder replacement surgery provides significant pain relief as well as improvement in range of motion in patients who have failed a prolonged course of conservative management.
Dr. Bassora is a Shoulder and Sports Medicine surgeon who specializes in shoulder reconstruction and sports related injuries of the shoulder, elbow and knee. He sees patients in Montvale, Paramus and Rutherford. For more information or to schedule an appointment, visit our website.