Shoulder Pain: Bursitis & Impingement
Shoulder pain is a common problem, with symptoms from ‘impingement syndrome’ being the most frequently seen complaint. It is a blanket definition that covers several more specific diagnoses that may include subacromial bursitis, tendon inflammation and degeneration, or issues arising with the acromio-clavicular joint.
While shoulder impingement can affect people of any age, Physiotherapists tend to see these problems emerge most frequently in two patient groups. Firstly, in a younger and athletic population, often those involved with throwing or overhead type sports. The second group is typically middle aged, with a frequency greater in women than men, and often in those for whom working or lifting above shoulder height is required.
Anatomically, the shoulder is an unstable joint, with a weak configuration of ligaments binding it. As a result, four small muscles known as the 'rotator cuff' provide it with extra stability. These muscles are collectively known as the rotator cuff, with more details of their injuries here. In many regions of the body, wherever a tendon passes close to bone there is a bursa nearby. A bursa is a membranous pocket of fluid that cushions the passage of the nearby tendon; hence the function of the subacromial bursa is to protect the rotator cuff tendons from wear by dissipating friction and allowing free motion between them and the overlying bone of the acromion process.
Inflammation is caused by a mechanical ‘pinching’ of the bursa or one of the rotator cuff tendons when the arm is elevated. Overuse degeneration of the rotator cuff may contribute, as may stiffness, hypermobility, or instability of the shoulder joint. Various acromion shapes, a history of trauma, and scapula instability associated with poor muscular control all play a role in the development of pain.
TREATMENT - How can we help you?
- Activity Modification is central to success. We can help advise you on this so that other treatments will be effective and give the affected tissues time to settle.
- Exercise programs include stretching, strengthening and the retraining of movements through the shoulder and scapula. These have been shown to improve pain, strength, shoulder motion and overall function. Your Physiotherapist can design and teach you an appropriate exercise regime.
- Manual Therapy: there is evidence that manual therapy combined with an exercise program provides greater results than exercise alone. Physiotherapists are well trained in manual therapy techniques that can successfully treat subacromial impingement.
- Dry needling, Electrotherapy (including ultrasound and interferential) and massage can help assist recovery and provide short term pain relief.
- Anti-inflammatory medication and corticosteroid injections may be useful in the short term. Medium and longer term benefits are doubtful.
- Surgery is a last resort and Physiotherapy treatment will in many cases be successful. The time of recovery with Physiotherapy will often be determined by the severity of the condition and may vary between several weeks and several months. Your Physio will advise you of any need for further investigations or medical input as the need arises. Unfortunately, not all impingement issues will respond well or fully to therapy, and in a small minority of cases surgery may be needed.
The shoulder is indeed a very complicated region of the body, so a thorough examination of your symptoms is necessary to provide a reliable diagnosis. Bursitis and impingement syndrome are just two of a wide array of problems around that shoulder that Physiotherapists will encounter and treat. Not only are there other structures in the shoulder that can sustain injury, but the area is commonly involved as a site of referred pain from the neck, scapula region and upper back.
Identifying the real source of your pain is where we come in, so you can rest assured that you are in capable hands and we will help steer you in the right direction!