Bursitis
Subacromial impingement (or bursitis) is a condition which can prevent correct shoulder movement.
The shoulder is a complex anatomical structure providing a greater motion range than any other joint.
Arm motion is facilitated by the synergistic motion of the collarbone, upper arm and shoulder socket, all working together. Shoulder pain and reduced movement occur if any of these structures become injured or damaged.
Subacromial impingement or bursitis?
The words 'bursitis' and 'impingement' describe different aspects of the same problem.
Subacromial impingement
Shoulder impingement causes the entrapment and compression of the rotator cuff tendons during shoulder movements.
A group of tendons located between the bones at the shoulder’s tip are part of the rotator cuff. These tendons usually slide easily within this area.
However, the space between the acromion (shoulder tip) and arm bone can become narrow, and the tendons are unable to fit through easily. This results in the rotator cuff tendons (located between the acromion bones and arm) pinching when the arm is raised higher than the shoulder. The tendons become more irritated and inflamed each time this pinching occurs.
Acromion bone shape changes can result in shoulder impingement. This change in shape may be caused by overuse, trauma or diseases (including arthritis). This condition is usually diagnosed using shoulder arthroscopy.
Shoulder bursitis
The subacromial bursa can also be affected by this compression.
Bursas are located between our bones and tendons and are sac-like structures that contain lubricating fluid. The purpose of bursas is to allow proper, smooth tendon gliding near our bones.
In our bodies, there are hundreds of bursas. If the bursae in the shoulder become inflamed, an individual experiences a condition called subacromial bursitis.
Subacromial bursitis is often the result of impingement, which occurs due to forceful or recurring shoulder use.
Furthermore, this condition can be caused by sporting activities requiring repetitive overhead motions (such as golf, tennis, swimming, or ball throwing), vigorous pulling movements, or overhead lifting. Knocking the shoulder can also lead to this condition.
Poor posture, incorrect stretching habits with regard to working out, and advancing age can also cause bursitis.
Symptoms of subacromial impingement or bursitis
Shoulder bursitis and impingement are usually indicated by continual pain which inhibits everyday activities.
Symptoms of these conditions can include:
- Pain from the elbow to the shoulder's top
- Pain in the shoulder, even when resting
- Inability to lie on the shoulder without pain
- Pain in the shoulder while sleeping
- Inability to place the hand behind the head or back without pain
- Pain and weakness of muscles when lifting or reaching
Individuals with subacromial bursitis may also experience shoulder swelling or redness. The shoulder may also induce pain if touched and feel 'hot'. If you have an advanced case of bursitis, you may also experience frozen shoulder, where movement of the shoulder becomes progressively limited.
Diagnosis of shoulder impingement /subacromial bursitis
A medical examination is the first step to diagnosing these issues.
Dr Brumby-Rendell will ask about your health history and symptoms, and will assess your shoulder through a physical examination.
Here, Dr Brumby-Rendell will test for shoulder tenderness and inspect any uncommon bone configurations. To ensure that the experienced pain is not caused by nerve problems, Dr Brumby-Rendell may also assess your neck area.
To test the movement capacities of your shoulder, Dr Brumby-Rendell will move your arm in various directions, and arm strength will be assessed. Shoulder subacromial impingement is usually evaluated using the Neer and Hawkins-Kennedy clinical diagnostic tests.
Treatment options
Non-Surgical treatment for shoulder impingement and subacromial bursitis
Shoulder impingement and subacromial bursitis are initially treated via non-surgical means. These measures focus on avoiding activities that contribute to the condition (such as overhead sports), reducing swelling through anti-inflammatories, and completing prescribed shoulder exercises to strengthen and stretch shoulder muscles.
Cortisone injections may be administered under ultrasound control if bursitis is not improved via exercises. These injections directly introduce anti-inflammatory to the bursa.
Some conditions will be resolved quickly after one treatment, whereas more complicated conditions may require a prolonged healing period. Surgery may be required for some bursitis or impingement cases to heal correctly.
Surgical treatment: Shoulder arthroscopy /subacromial decompression
Pain caused by shoulder impingement and subacromial bursitis may be relieved via subacromial decompression. Dr Oscar Brumby-Rendell is highly qualified in implementing arthroscopic approaches and can perform this surgery with minimal invasiveness.
Is this procedure right for me?
You may be eligible for this procedure if you have been diagnosed with shoulder impingement and have seen no results after 4 to 6 months of non-surgical treatment.
Subacromial decompression increases space for tendons located below the acromion to correct shoulder impingement. Subacromial bursitis can also be treated by removing inflamed bursa tissue or the entire bursa (which will grow back).
During surgery
During this arthroscopic (keyhole) procedure, Dr Oscar Brumby-Rendell will make small incisions in the shoulder and insert a small camera and surgical instruments, allowing him to view the surgical site without creating a large wound.
In this procedure, the coracoacromial (CA) ligament is cut, and a portion of the acromion bone is shaven. This reduces muscle pressure, enables tendons and muscles of the rotator cuff to move easily, and promotes proper healing. Any bone spurs may also be removed.
This procedure has a quick healing period and minimal pain due to its arthroscopic measures. There is no need to stay overnight after this surgery. As this is not an open surgery, infection risks, tissue damage, and blood loss are minimised.
After your surgery, your wounds will be dressed, and you will wear a sling for arm comfort. Both the dressing and sling can generally be removed after 48 hours.
Risks associated with subacromial decompression
Being a surgical procedure, there are specific risks associated with arthroscopic subacromial decompression. These may include:
- Infection
- Swelling
- Anaesthesia risks
- Nerve and blood vessel damage
- Continued shoulder pain post-surgery
- Continued symptoms, potentially requiring further surgery
More post-operative information
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