Shoulder Bursitis

Shoulder bursitis is a very common condition in which the area surrounding the shoulder tendons becomes irritated.  Many cases develop suddenly after increasing activity; others develop slowly over time as a result of degenerative changes around the shoulder. This condition is very common in patients between the ages of 40 and 55.  Most patients do not describe and injury prior to their symptoms.  Overhead activities tend to aggravate the inflammation.  Many patients have a difficult time sleeping because their shoulder seems to hurt worse after laying down. The pain from bursitis is usually not felt in the shoulder but along the upper, outer arm in the area of the deltoid muscle.  Many patients are referred over for "arm pain".

The cause of sub-acromial bursitis are not well understood but there appear to be two mechanisms for developing symptoms.  The first type is mechanical pinching of the bursa or rotator cuff tendon leading to inflammation.  Most patients with bursitis have extra calcium deposits on the anterior lip of the acromion, a plate like bone on the top of the shoulder.  With activity, this extra calcium can cause mechanical pinching of the rotator cuff tendons especially with repetative overhead activity.  Once the tendon and bursa are inflammed, they tend to swell and this leads to even less clearance under the acromion.  This sets up a viscious cycle of inlammation and swelling that persists until the calcium deposits are removed.

The second type of bursitis is the result of an overuse injury which causes inflammation of the bursa and tendon.  This type tends to be more sudden in onset with very sharp pain in the shoulder and arm.  I commonly see this type of bursitis after the patients attemps and ambitious weekend remodelling project, especially involving drywall, with repetative overhead motion and lifting. Unlike impingement, this type of bursitis is often cured with one or two corticosteroid injections.

 Most patients describe a sharp pain in the upper/outer arm when lifting their arm overhead or trying to put on a jacket.  Strength and motion are preserved, but painful.  Initial treatment includes activity modification, anti-inflammatory medication and corticosteroid injection.  If the condition persists I add physical therapy.  In refractory cases, I proceed with an MRI and occasionally surgery is required to remove the inflamed bursa. This is done as an outpatient procedure with minimally invasive arthroscopic techniques.