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Shoulder Bursitis


The shoulder is a ball and socket joint whose articulations allow for a wide range of motion. This extensive range of motion allows individuals to participate in a variety of activities such as throwing, tackling, swinging, or performing a headstand. However, this wide range of motion in the shoulder joint occurs at the cost of decreased stability. As a result, the shoulder joint is particularly vulnerable to a variety of injuries such as dislocation, impingement, rotator cuff tear, arthritis, separation, and bursitis. This article describes the causes and symptoms of shoulder bursitis and identifies certain strengthening exercises that may cause or exacerbate an existing bursitis condition.

The bursa is a fluid filled sac found in those areas in the body where friction between tissues might occur. Bursae are located predominantly between bony prominences, muscles, or tendons. Their main function is to provide cushion and support in areas where repetitive motion occurs. Overuse of muscles or tendons in regions where bursae are found, as well continuous external compression or trauma, can cause bursitis. Symptoms include swelling, pain, and often a loss of muscular strength and range of motion. Repeated cumulative trauma may eventually lead to the formation of calcium deposits and to degeneration of the internal lining of the bursa.

Shoulder bursitis is a common disorder often seen in athletes who participate in sports that require repetitive throwing and swinging motions and who use the shoulder joint throughout its entire range of motion, such as in swimming, gymnastics, and wrestling.

There are several bursae in the shoulder region: the subacromial, the sub deltoid, the subcoracoid, and the subscapular, which, as their names imply, lie beneath the acromion, deltoid, coracoid, and scapula, respectively. In the shoulder region, there are also bursae beneath the pectoralis major and in front of and behind the tendons of the latissimus dorsi. These are filled with synovial fluid and are located deep within the tendons and muscles. The main function of the bursae is to facilitate the gliding of soft tissue structures over bony surfaces.

Although any of the above mentioned bursae can become irritated, inflamed, and painful as a result of overuse of or trauma to the shoulder region, the subacromial bursa is by far the most frequently afflicted. Irritation is usually a result of friction, which causes the lining of the bursa to thicken, thus increasing the amount of friction and, in some cases, creating a fold. In turn, this affects the normal gliding movement of the soft structures over the bony structures of the shoulder. The condition also makes movement in the area rougher, sometimes causing a kind of snap, particularly in abduction and rotation, as the humerus moves.

The apparent pathology of shoulder bursitis involving the subacromial bursa is attributable to a fibrous build-up and to the presence of fluid that accumulates as a result of the area's constant inflammation. What is usually referred to as bursitis is typically caused by abduction and external rotation and characterized by pain that originates in the subacromial region. In fact, the injury also involves the musculotendinous cuff and the biceps' tendon and sheath, and not just the bursa itself. Pain results when the arm is abducted laterally through a range of 70 to 110 degrees. The pain decreases as it continues upward. This pain is caused by an impingement of the inflamed structure lying beneath the acromion process and the coracoacromial arch.

The symptoms of shoulder bursitis include a limited active range of motion and pain, especially during shoulder abduction and internal and external rotation. The client may also report tenderness upon palpation of the deltoid and the acromion, and if the condition has been present for several weeks or longer, muscle atrophy may be noticeable as well.

A recommended treatment for shoulder bursitis is applying superficial heat in the form of moist pads or infrared rays and deep heat in the form of diathermy or ultrasound; however, cold pack applications are sometimes more beneficial than heat treatment, which occasionally aggravate symptoms. For more serious cases, ultrasound therapy helps greatly. It is very important to strengthen the weakened musculature in order to regain long-term stability.

Therapy is often important to prevent the onset of a secondary symptom known as "frozen shoulder," which, while generally characteristic of older patients, sometimes occurs in younger and more active individuals. Frozen shoulder is described as a chronically irritated shoulder joint that has been improperly or inadequately cared for. According to D.D. Arnheim in the Modern Principles of Modern Athletic Training, "Constant, generalized inflammation causes degeneration of the tissues in the facility of the shoulder joint, resulting in extreme limitation of movement." The main cure for frozen shoulder is a combination of deep heat therapy, such as ultrasound and mobilization exercises.

No matter what type of treatment for shoulder bursitis is chosen, the ultimate goal is to regain full range of motion and to prevent adhesions and muscle contractures from immobilizing the joint. Once range of motion is regained in the shoulder area, the patient can begin shoulder exercises to rebuild strength and to avoid further injury.

Although shoulder bursitis appears inherent in sports that emphasize throwing or stroking movements, such as baseball and swimming, it very often can be avoided or minimized through proper physical conditioning and by foregoing exercises that may lead to or worsen an existing shoulder bursitis condition.

The following exercises performed in excessive repetition, with excessively heavy loads and/or in a fast and uncontrolled manner, may cause symptoms associated with bursitis of the shoulder: pressing movements including the bench press, military press, incline press, decline press, and pushups; behind-the-neck latissimus pull-downs and behind-the-neck military or overhead presses; reverse flies performed with dumbbells or pulleys; clean and jerks; snatches; pec-decks; and dumbbell flies. All of these exercises involve a certain amount of shoulder abduction and internal or external rotation. Because of the potential for harm that exists if these exercises are executed improperly, the National Academy of Sports Medicine recommends that they be done initially under the guidance of a certified personal fitness trainer.

Dr. Cady can help to stabilize your shoulder and return it to a normal state. Once it is more stable, exercises help to keep your shoulder stable. Dr. Cady had shoulder bursitis in his left shoulder and 'practiced what he preached' by using ice, ultrasound and exercises to stabilize his shoulder. He continues to do exercises twice weekly, and has had no problems in either shoulder for 2 years now.

Call us today at 408-739-2273 for an appointment!