Bursitis of the Shoulder

Shoulder Joint Overview

The shoulder joint is the most mobile joint in the body and is made up of bones, muscles, tendons, ligaments and synovial tissue. It is made up of 6 major bones: the shoulder blade (scapula), the collarbone (clavicle), the upper arm bone (humerus), the acromion process, the greater tubercle and the glenoid fossa (the ball at the top of the humerus). The shoulder is a "ball and socket" joint, which holds the ball (the glenoid fossa) in the socket (the shallow, depressed area called the glenoid cavity, located on the outer edge of the scapula).

The rotator cuff muscles (supraspinatus, subscapularis, infraspinatus and teres minor) are connected individually to a group of flat tendons, which fuse together and surround the front, the back, and the top of the shoulder joint like a cuff on a shirt. The tendons attach the muscles to the bone and allow movement in the shoulder, as well as providing strength to hold the ball in its socket. They are involved in all shoulder motions.

The rotator cuff ligaments attach bone to bone and provide stability to the shoulder joint bones.

Bursae in the Shoulder

Bursae (plural for bursa) are flattened sacs that function as cushions between your bones and the muscles (deep bursae) or bones and tendons (superficial bursae) to reduce friction and allow your soft tissue to slide over bone effortlessly during muscle contraction. They are lined with synovial cells that secret fluid that is rich in protein and collagen and act as the lubricant between areas in your body where friction (rubbing) is greatest.

These fluid-filled sacs form in areas where 2 surfaces in your body, most often where a bone and tendon or a bone and muscle, rub together during movement. When pressure or friction is too great, excess fluid can build up in the bursa sac causing inflammation. When a bursa becomes inflamed, moving the affected area becomes very painful and movement can be difficult. Any actions that put pressure on the inflamed bursa can increase irritation and cause further inflammation and pain.

In amongst your bones, muscles and tendons in the shoulder there are 8 bursae, the most of any single joint in your body. The major bursae in your shoulder include: the subscapular bursa, the subdeltoid bursa, the subacromial bursa, and the subcoracoid bursa. The subscapular bursa is located between the tendon of the subscapularis muscle and the shoulder joint capsule. The subcoracoid bursa sits between the coracoid process of the scapula and the shoulder joint capsule. The subacromial bursa is situated below the acromion process and above the greater tubercle of the humerus lessening the friction when you move your arm or raise it overhead. The subdeltoid bursa is located between the deltoid muscle and the shoulder joint cavity and is usually joined to the subacromial bursa.

Your bursae play an important role in leading a healthy, active life. When the bursae are not irritated and working properly, your joints move smoothly and painlessly. However, when a bursa becomes swollen and inflamed, the condition is known as bursitis. As you know, when you suffer from bursitis you will experience pain during physical activity.

Understanding Shoulder Bursitis

Although all of the bursa in the shoulder can become inflamed due to trauma, infection or other conditions, the subacromial bursa is the most commonly inflamed. Frequently, bursitis in the subacromial bursa occurs with tendonitis in the supraspinatus tendon, although you can experience these conditions independently. Since the subacromial bursa and subdeltoid bursa are usually joined together, inflammation in one usually results in inflammation of the other. Overstraining, infection, abnormal bone growth or trauma in the rotator cuff can cause rubbing in your shoulder joint, inflaming the tissue in the area.

Even mild inflammation of your tendons or bursa can produce redness, swelling, and soreness and failure to take action against the inflammation can lead to bursitis and/or tendonitis. If this occurs, the bursa or tendon can become enlarged and the area between the acromion process and the top of the humerus (the subacromial space) may decrease causing the bursa or tendon to rub against the acromion.

If the space becomes too crowded, the acromion can begin to pinch the bursa or tendon (impingement) when your arm is raised in a forward, reaching or overhead position causing further irritation and swelling. This condition is often referred to as swimmer's shoulder, pitcher's shoulder, tennis shoulder, or shoulder impingement syndrome. This impingement can cause further inflammation in the bursa. In addition, degeneration of the tendon can occur which frequently results in a major rotator cuff strain and/or tear. If this continues, your pain will get worse and your tendon may split or completely tear away from the bone. Without prompt, proper treatment of bursitis with cold therapy, ultrasound therapy and Blood Flow Stimulation Therapy to heal the tissue, you may experience severe tissue damage and surgery may be necessary.

Traumatic bursitis in the shoulder is often due to overuse or repetitive actions common in athletes or workers who use frequent overhead arm movements such as throwing a ball, swinging a racquet, swimming, lifting weights, dusting high shelves, painting, or completing manual labor tasks. It can also be a result of something as simple as an awkward fall or trying to lift something up high with a weakened shoulder.

People most susceptible to shoulder bursitis are older than 40 years of age and/or have bone spurs on one of their shoulder bones. However, these injuries can also affect younger people who often partake in new or repetitive activities, are already injured and/or have chronic weakness in their shoulder.

Symptoms of Shoulder Bursitis

Pain

If you suffer from subdeltoid or subacromial bursitis you will experience painful shoulder movements, particularly during activities requiring abduction and extension. To diagnose your bursitis, the doctor may ask you to extend your arm out and he/she will apply resistance as you try to move it back towards your body. If the pain increases you may be suffering from bursitis, although other rotator cuff injuries and tendonitis can produce similar pain patterns.

The pain of bursitis starts gradually, originating deep inside your shoulder, and develops over a few days or even months. You will usually feel the pain on the outside of the shoulder and it may spread down the outer arm towards the elbow. If you raise your arm above your head, as you would when washing your hair or reaching high to get something off a shelf, the pain will worsen.

Difficulties Sleeping

Patients suffering from shoulder bursitis may also have interrupted sleep patterns. Simply rolling over on the affected shoulder during the night can cause pressure on the inflamed bursa increasing the pain at the pressure point. The pain can range from mild to very sharp depending on the amount of inflammation in your shoulder.

Tenderness and Swelling

A physical examination of your shoulder will show tenderness and usually warmth and swelling of the bursa and possibly the tendons as well. The tenderness will appear over the lateral shoulder and the subacromial space. There may be redness on your skin over the area.

Limited Range of Motion and Weakness

When you have bursitis in your shoulder, the pain is often limiting as you stop performing motions that make the pain worse. If bursitis is left untreated the inflammation can increase, causing more pain, limiting movement even more and eventually weakness in the shoulder muscles and tendons can set in.

It is important to treat bursitis to reduce these symptoms, minimize damage and maintain rotator cuff motion and strength. Without proper care, you may experience other painful conditions such as calcific tendonitis, frozen shoulder or a rotator cuff tear. By treating your shoulder bursitis in the early stages, you are more likely to prevent long-term damage and chronic conditions from setting in.

How to Treat Shoulder Bursitis

Once your medical professional has diagnosed you with bursitis you can begin proper treatments. If your bursitis is caused by an infection (septic bursitis), the doctor will probably drain the bursa sac with a needle and perscribe antibiotics to treat the infection.

For non-infectious bursitis, the preliminary treatment starts with non-operative options such as ultrasound thereapy, cold therapy and Blood Flow Stimulation Therapy. Surgery is normally not required for bursitis, however if you fail to see improvement with the conservative treatments, your physician may recommend surgery to remove the bursa completely.

The most important factor in healing bursitis (and tendonitis) is reating the area. During your recovery you will probably have to modify or avoid the activities that stress your bursa until your pain and inflammation settle. Scar tissue can often develop with tendinitis and/or bursitis. As your damaged tissues heal this dead, fibrotic tissue will be produced instead of forming brand new healthy tissue. This tissue adheres to your muscle fibers, tendons, ligaments, fascia, and nerves causing pain and preventing them from moving properly (this limits your range of motion, flexibility and strength). However, the more diligent you are with your treatment and rehabilitation, the faster you will see successful results.

Your initial treatment should involve decreasing swelling, relieving pain and stress on the shoulder, correcting any biomechanical dysfunction, and then restoring strength and mobility to your injured shoulder. It is important to follow any instructions you receive from your physician. If you are performing an activity that could cause further trauma to the bursa, it is recommended that you protect the area with padding and/or proper equipment to prevent further irritation or damage.

To decrease inflammation and relieve pain caused by shoulder bursitis rest your shoulder and limit your overhead activity to prevent impingement or further pressure on the inflamed bursa. Then use cold therapy, ultrasound therapy and Blood Flow Stimulation Therapy (BFST) to rid yourself of bursitis.

Cold Therapy

Applying cold to your inflamed bursa will help decrease the swelling and redness around the bursa. Cold therapy will also help to numb the pain in your shoulder joint and help to control the inflammation.

Icing the bursa as needed throughout the day, for approximately 15 - 20 minutes at a time, is recommended to reduce pain, swelling and inflammation. Do not apply ice directly on your skin, rather wrap it in a cloth or towel or, better yet, use a cold gel pack that fits easily and comfortably to your body.

The cold compression Shoulder Freezie Wrap™ can be used to apply cold in a safe, convenient and effective way - and the gel pack is reusable. The gel pack sits over the inflamed bursa in your sore shoulder to reduce swelling and redness. The wrap is soft and adjustable so it fits your body properly, without irritating the bursa, and allows you to adjust the compression. This is important when treating an inflamed bursa because too much pressure can cause you further pain. You control how much pressure the bursa receives so you can benefit from the compression to hold the cold where you need it, without increasing your pain.

Applying cold to your tender joint is the first step in treating your bursitis. Once severe inflammation has been reduce, you can begin using ultrasound therapy and Blood Flow Stimulation Therapy to continue the healing process.

Ultrasound Therapy

Ultrasound has been used by physical therapists and chiropractors for years to treat bursitis. By applying ultrasound therapy to your sore bursa (and tendon if you suffer from tendonitis as well) you can reduce the inflamed fluid that has built up in the bursa. In addition, ultrasound therapy will treat any other soft tissue conditions that you may be experiencing in your shoulder such as gout, calcific tendonitis, a torn rotator cuff and more. By treating yourself with ultrasound everyday, you are able to rid yourself of bursitis pain; this is best accomplished with a personal, therapeutic ultrasound device.

Ultrasound therapy is a great therapeutic option to decrease inflammation, pain and soft tissue (muscle, connective and nerve tissue) damage experienced with shoulder bursitis and other shoulder injuries. The treatment is easy, painless, and generally requires between 5 - 10 minutes of your time. It is based on a form of deep thermal therapy which is generated through high frequency sound waves that reach into the cells of the tissue. These sound waves help to reduce the fluid build up in the bursa, heal any tissue damaged through trauma, reduce scar tissue, as well as reduce any crystal or calcific deposits that may have gathered in the area.

The sound waves send vibrations into your bursa and surrounding tissue to raise the temperature of your soft tissue. By raising the temperature, blood flow increases to the area, delivering nutrient filled blood to heal the area and whisking away the excess fluid and damaged tissue. The waves are delivered through a hand held transducer along with MendMeShop medicinal conductive gel in a slow, circular motion on your skin over the injured area.

If not treated properly, injured tissue can heal with a weakened state which can lead to scar tissue or calcification, adding to the bursitis pain you are already experiencing. If used on an ongoing basis, ultrasound will help to increase the range of motion in your shoulder by breaking down any scar tissue that may form in your rotator cuff because of bursitis and/or tendonitis.

The MendMeShop Ultrasound Therapy System is the device you need to treat your bursitis once and for all. It comes with a bottle of the MendMeShop Lavender Infusion Gel so you get two therapies in one. The medicinal ingredients of natural Bulgarian lavender, eucalyptus, peppermint and menthol help to stimulate blood flow, widen blood vessels to enhance blood flow, and act as an anti-inflammatory deep in the tissue to enhance your ultrasound therapy through a process called phonophoresis.

Blood Flow Stimulation Therapy

When your bursa is injured and inflamed, your body needs a fresh supply of blood to rid the area of inflammation and get your bursa and any other damaged tissue back to normal. Unfortunately, when you have bursitis in your shoulder it is painful to move your arm. When you limit movement in your shoulder joint the blood flow is reduced, starving your tissue of the necessary oxygen and nutrients. The trick is to find a way to increase the healing flow of blood without causing pain in your shoulder and/or further inflaming the bursa. This is where Blood Flow Stimulation Therapy (BFST) becomes a powerful tool. BFST compliments your body’s natural healing process by promoting the flow of blood to your shoulder while you give it the rest it needs.

The Shoulder Inferno Wrap™ uses a patented process to generate the same energy that is part of the sun's spectrum of light, the same energy that is necessary to all living things for optimum health. The energy emitted from the Energy Web™ delivers waves to the bursa and surrounding tissue and stimulates blood flow to your shoulder. By reaching deep into your shoulder bursa and tendons, you are able to reduce the inflammation in your bursa and whisk away the toxins that build up from inflammation and tissue damage.

Once you have calmed the pain and inflammation in your bursa with the use of the Shoulder Freezie Wrap™ you can begin the healing process with ultrasound therapy and BFST. This 3 step process is the most effective method to treat your swollen and painful bursa, reduce the inflamed fluid in the bursa and heal any tissue damage in your shoulder.

Pain and Anti-inflammatory (NSAIDs - Non-steroidal anti-inflammatory drugs) can be used if required to help manage your pain. However, these aren't recommended for long term use, as they can cause gastrointestinal difficulties and increase the risk of cardiovascular disease. The use of cold therapy, ultrasound and BFST in conjunction with NSAIDs can greatly improve the effect of this medication and can help to heal quicker.

Rehabiliation Exercise

Physical Therapy is a beneficial way to restore atrophied muscles and improve shoulder strength and mobility after treating shoulder bursitis. The type of physical therapy and the duration will be dependent on the tissue damage and your symptoms. When you are treating or recovering from bursitis, it is important to ensure you do not perform any exercises that will further irritate the bursa.

Once your pain starts to diminish, a physiotherapist will set up an individualized shoulder strengthening and stretching exercise program for you to perform at home or in the gym. This will be based on your needs and abilities, and will help you return to performing your normal routines. Individuals will often lift weights on their own, to try and build up their shoulder strength. However, in doing so, they can do more damage to their shoulder. It is extremely important to strengthen your muscles properly, as they may have weakened during the period of non-use. A trained therapist will help to ensure your rehabilitation process is effective. For best, long term results use ultrasound and BFST in conjunction with physical therapy and an exercise program.

During your recovery, you may have to modify and/or eliminate any activities that cause pain or discomfort in your shoulder area until your pain and inflammation settle, and you gain more mobility and strength in your shoulder. The more diligent you are with your rehabilitation, the faster you will see successful results.

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