SHOULDER Bursitis

Shoulder bursitis is also known as shoulder impingement or rotator cuff tendonitis. It can be caused by injury, overuse, or a bone spur in the shoulder.

Bursitis is an inflammation of a bursa, which is a small fluid-filled sac found around a joint. It acts as a cushion between moving parts in the joint to stop muscles, bones, and tendons from rubbing together.

When your shoulder bursa gets irritated, it becomes inflamed and develops scar tissue. This causes inflammation of the muscles and tendons. Their role is to move the shoulder, and the inflammation can cause pain and loss of movement in the shoulder.

A common cause of shoulder bursitis is overuse of the shoulder joint, especially if that activity is performed repetitively or overhead. If you are doing sport or  work that involves repetitive movements it can put stress on your shoulder joint. It is also important to be careful with exercises that require repetitive movements.

In the field of shoulder and knee reconstruction, successful outcomes from an operation are 50% surgery and 50% rehabilitation. You could say the surgery is the easy bit, the rehabilitation is all hard slog. Dr Colvin’s CO.RE exercise programs are just that, a core plan for your successful recovery.

Non-operative treatment is always the best place to start. Firstly, this means avoiding the activities which have precipitated the pain. Over-the-counter drugs such as Panadol and Nurofen are a safe way to control the pain. Anti-inflammatories reduce swelling in the rotator cuff tendons. It is advisable to see a physiotherapist for a set of shoulder exercises aimed at stretching and building strength through the rotator cuff muscles.

Cortisone injections into the subacromial bursa are a very successful minimally invasive treatment for shoulder bursitis. The injections are done by a radiologist with ultrasound guidance. Cortisone works as a powerful anti-inflammatory, reducing tendon swelling and breaking the cycle of impingement. It is not uncommon to require up to three injections, done once a month, to get symptoms under control.

Surgery is not the first treatment option, but should be considered if conservative treatments including injections and physiotherapy have failed and the symptoms are continuing for three to six months or more.

The first thing that surgery achieves is removal of the inflamed bursa and scar tissue. More importantly, the surgery shaves away some of the bone and any spur. This increases the space available for the tendons and stops the tendon rubbing process.

The operation is called 'subacromial decompression' or 'acromioplasty'. It is arthroscopic surgery done with two small keyhole cuts.

A sling will be required for a few days but should be discarded as soon as possible. It is very important to get things moving as soon as possible. This stops scar tissue developing, keeps the capsule flexible, and prevents the muscles from losing strength. Don’t worry about doing damage, move the shoulder as much as pain allows. The hospital physio will start your rehabilitation the day after surgery.

Acromioplasty or Subacromial Decompression involves shaving the bone. It takes at least three months for the bone to grow a new smooth surface and for soft tissue inflammation to settle. Most patients are aware of an improvement three months after surgery but it may take longer for symptoms to resolve completely and for full strength to recover.

For more information, please call Dr David Colvin's team on 08 9489 8788 to make an appointment.