Why does the bag become inflamed?
The space between the acromion of the scapula and the head of the humerus is narrow. When a person repeatedly raises their arms above shoulder level, the tendons and bursa rub against the bony edge. With constant overload, the bag swells, its walls thicken, and there is even less free space - a vicious circle is formed. This is facilitated by the shape of the acromion, calcium deposits in the tendon, weakness of the scapula muscles and stooped posture. Less commonly, bursitis is associated with a direct blow, gout, or an infection in the bursa.
- Repetitive work with raised hands
- Weakness of the muscles that stabilize the scapula
- Slouching and altered shoulder biomechanics
- Calcification of the rotator cuff tendons
- Direct shoulder injury
- Gout and other metabolic disorders
- Rarely - infectious bursitis
Symptoms
The pain is located on the outer surface of the shoulder and often radiates to the middle third of the humerus, but not below the elbow. A typical symptom is a painful arc: the movement begins freely, then a sharp pain appears at a certain part of the ascent, and with further ascent it decreases again. It hurts to comb your hair, take an item from the top shelf, put your hand behind your back, or put on a jacket. At night, a person wakes up if he rolls onto his sore shoulder. Arm strength is usually preserved, although pain makes movement seem weak.
- Pain on the outer surface of the shoulder
- Painful arch when raising the arm
- Increased pain at night on the affected side
- Difficulty placing your hand behind your back
- Pain when moving, but not at complete rest
- Arm strength is generally preserved
Diagnostics
The diagnosis is largely clinical: the doctor performs functional tests that show which structures are involved and checks the strength of individual rotator cuff muscles. Ultrasound of the shoulder joint is a convenient and accessible method: it shows fluid in the shoulder joint, thickening of its walls, the condition of the tendons and calcifications, and also allows you to examine the shoulder in motion. X-ray helps to evaluate the shape of the acromion, calcium deposits and exclude arthrosis. MRI is prescribed when there is a suspicion of a rotator cuff tear or treatment does not have an effect.
- Inspection with functional tests
- Ultrasound of the shoulder joint
- X-ray of the shoulder joint
- MRI for suspected tendon rupture
- Tests for inflammation if infection is suspected
- Uric acid for suspected gout
Treatment
The first task is to remove the provoking load, but not to immobilize the hand: prolonged fixation leads to stiffness. In the acute period, cold, rest from movements above the head and anti-inflammatory drugs prescribed by a doctor help. The basis of recovery is physical therapy: exercises on the muscles of the scapula and rotator cuff return correct biomechanics and expand the subacromial space. If the pain is severe, your doctor may inject a glucocorticoid into the bursa, but such injections are not done often because they weaken the tendons. Surgical treatment is rarely required.
- Temporary refusal to move above the head
- Cold in the acute period
- Anti-inflammatory therapy as prescribed by a doctor
- Therapeutic exercise is the main method
- Physiotherapy as an adjunct
- Injection into the bursa for severe pain
- Arthroscopic treatment when conservative therapy is ineffective
Prevention and return to exercise
After the pain subsides, it is important not to immediately return to the previous amount of stress: this is how bursitis recurs. The return is built gradually, starting with movements below shoulder level and strengthening the muscles of the shoulder blade. The workplace should be organized so that frequently used items are at waist and chest level, and not above the head. It is useful for athletes to review their technique, and for those who work a lot at the computer, to monitor their posture. Regular exercises for the mobility of the thoracic spine relieve the shoulder.
- Gradual increase in load
- Strengthening the scapula and rotator cuff muscles
- Organization of a workplace without overhead work
- Correction of technique in sports
- Working on posture and thoracic mobility
- Breaks during monotonous manual work