Shoulder bursitis and its therapeutic management

What is bursitis or impingement syndrome?

To understand the mechanism of impingement it is important to know a bit of shoulder anatomy. There are four small muscles which collectively form a band or cuff around the shoulder joint to give it more stability. The bones and ligaments supporting the shoulder form an arch over this band or ‘rotator cuff’ within the joint cavity. In between the arch and the rotator cuff there is a fluid filled sac called as subacromial bursa which is naturally designed to prevent friction. 

Repeated shoulder movements and overhead abduction leads to inflammation and irritation of this bursa and patient experiences peculiar kind of pain as he moves shoulder beyond 90 degrees.

How is it categorized?

Primary

This is common for conditions like osteoarthritis where joint space narrows and impinges on bursa naturally. However, doing too much of overhead shoulder movements like working for high shelves or throwing basketball makes rotator cuff to continuously squashing against the bone thus causing bursitis.

Secondary

Poor posture, sedentary lifestyle or repeated overhead abduction can cause laxity in shoulder. The rotator cuff in this case, has to work far more to stabilize the shoulder joint. But with time it is bound to get fatigued and weak which will in turn allow arm bone to rub against the rotator cuff muscles. 

Bursitis can develop slowly and eventually with sports activities like basketball, tennis or volley ball to those who are occasional players.

 What are the clinical signs of bursitis

•          Shoulder pain typically at the tip of the arm.
•          Reduced range of motion.
•          Shoulder and arm muscles weakness.
•          Everyday activities like combing, washing hair, toweling or reaching out for anything becomes difficult.
•          Patients who are habitual of sleeping on the painful shoulder may get pain at night or early mornings.

Managing impingement syndrome

Physical therapy:

Physical therapy  focuses on reducing pain and inflammation initially instead working upon muscular stability. Physical therapy is chosen as the first line of treatment for impingement syndrome. This includes use ice packs in the form of air casts or cryo cuffs to bring down swelling and inflammation. 

As swelling subsides patient can be given ultrasonic therapeutic massage or modified TENS currents to alleviate pain in the surrounding soft tissues. This lightens the entire arm and prepares the patient to perform the desired exercises.

Functional mobility:

This is done by improving efficiency of the arm by sets of exercised using pendulums, shoulder wheel, pulleys and other resistive exercises by using thera bands or cords to strengthen the shoulder at the center for sports physical therapy.

Postural correction:

Teaching the patient correct body mechanics to reach forward or backwards during everyday activities, and lifting weight along with right way of aligning head with shoulders and spine will make patient aware of any upcoming discomfort.

Medications:

Anti inflammatory, analgesics and steroid injections are common medications for bursitis.