Subacromial bursitis

definition

Subacromial bursitis is the inflammation of a bursa in the shoulder joint, the Subacromial bursa. This bursa is located between the tendon of the Supraspinatus muscle and the angular shoulder joint (acromioclavicular joint or AC joint, consisting of the raven beak process (Acromion) and the outer end of the collarbone (Clavicle)). Bursae serve practically as a "shifting layer". They reduce the mechanical stress on bones or muscles

A distinction is made between an acute and a chronic form of this inflammation. It is one of the most common shoulder diseases and is associated with severe pain.

causes

As a rule, subacromial bursitis is the result of excessive or incorrect loading of the affected shoulder.
Particularly at risk are people who regularly have to perform a certain movement in which the arm has to be raised above their head, for example tennis players or teachers writing on the blackboard. If such a load persists over a long period of time, minimal injuries to the bursa occur again and again, which are initially not noticed. Over time, these so-called “microtraumas” then lead to an inflammatory reaction in the bursa.

Certain cells proliferate and produce more fluid and collagen. In addition, as a reaction to constant mechanical irritation, calcium is often formed and stored in the tendons under the roof of the shoulders. If this lime penetrates the bursa, it also promotes the inflammatory reaction.

A special feature of the shoulder joint is that the Subacromial bursa has hardly any opportunity to expand. The deltoid muscle, the bony structures and the tendons limit the bursa very tightly. For this reason, in the case of subacromial bursitis, compared to other bursitis, pronounced joint effusions with swellings are less common, and movement is restricted more quickly.

Other factors that can promote the development of bursitis in the shoulder are physical (excessive heat / cold, UV light, ionizing radiation) or chemical (heavy metals, poisons, acids, alkalis) irritations, a derailment of the body's enzyme balance or foreign bodies in the shoulder.

It is less common for subacromial bursitis to develop in the context of an underlying disease, for example malignant tumors, diseases from the rheumatic group (especially rheumatoid arthritis) or metabolic diseases such as gout.

Read more on the topic: Bursitis

Appointment with a shoulder specialist

I would be happy to advise you!

Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of .

The shoulder joint is one of the most complicated joints in the human body.

The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

Directly to the online appointment arrangement
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You can find more information about myself at Carmen Heinz.

Symptoms

The main symptom of subacromial bursitis is severe pain. The pain of a bursitis of the shoulder does not only exist during movement, but also at rest and in many patients even during the night.

In the course of the disease, the pain is accompanied by a more or less pronounced restriction of movement of the shoulder joint, which can be accompanied by a weakness in this joint. Occasionally, there are other symptoms typical of inflammation such as overheating or redness. In contrast, swelling in the shoulder area is extremely rare in subacromial bursitis.

Nocturnal pain

Inflammation causes pain, at the beginning often only when the respective structure is stressed or stressed. The more pronounced the inflammation, the more likely it is that the pain will manifest itself at rest or even at night. An inflammation of the bursa in the shoulder (bursitis subacromialis) can disturb the night's sleep, as various sleeping positions can irritate the affected bursa or simply put pressure on the affected shoulder.

Restriction of movement

The clinical picture of the "frozen shoulder" describes a chronic inflammation of the shoulder joint capsule (not the subacromial bursa!), Which leads to a temporary stiffening of the shoulder joint due to inflammatory adhesions. Patients between the ages of 40 and 60 are particularly often affected, women more than men. In some cases, both shoulder joints can be affected at the same time, but the cause of this inflammatory disease is not yet understood. The symptoms can last for months or even years and range from mere pain in the shoulder to more or less pronounced restrictions on movement. Therapeutic measures can include conservatively prescribed painkillers, anti-inflammatory joint injections or surgical splitting of the shoulder joint capsule.

Loss of strength

Since subacromial bursitis is an inflammation of the bursae below the roof of the shoulder in the immediate vicinity of the shoulder joint, a functional restriction in the joint is often associated with it. Because the affected bursa is in the space between the shoulder joint and the roof of the shoulder (part of the shoulder blade) and this becomes narrower, especially during arm movements such as lifting the arm between 80-120 ° to the side or to the front, many everyday movements cause pain . In addition, movement restrictions and a significant reduction in strength in the shoulder can also be seen.

Duration

The duration is heavily dependent of the Severity of inflammation and the triggering factors.
Occurs the bursitis first appearance in form of slight irritable pain after an unusual movement in the shoulder, the duration is the Complaints often brief.
By not moving, the inflammation can subside within a few days.

Will the Symptoms ignored longer, which can lengthen the duration of the complaints. Despite anti-inflammatory therapy, the Healing takes several weeks.

The disease persists for a very long time latent inflammation, that occur due to permanent, for example job-related movement.
Of the Pain can be chronic persist for months and do not respond to conventional therapies. Chronic pain is often referred to as pain that has persisted for more than 6 months.
Reason for chronification is often the fact that the triggering factor subacromial bursitis is not treated.
Read more about the topic here: chronic pain syndrome

Diagnosis of subacromial bursitis

The diagnosis of "subacromial bursitis" can usually be made by taking a medical history (anamnesis) and a thorough clinical examination.
The pain when the affected arm is raised to the side between 80 ° and 120 ° is very typical (impingement syndrome is an important differential diagnosis here! Various clinical tests that suggest the presence of an impingement syndrome, for example the Neer's sign or the speed Test). If in doubt, an X-ray image (in which calcium deposits become visible), an ultrasound or an MRI of the shoulder (magnetic resonance scan of the shoulder) can be carried out. Here, the soft parts such as muscles and ligaments can be easily visualized, and any existing joint effusion can also be discovered.

Important differential diagnoses (alternative causes) of subacromial bursitis are:

• degenerative changes in the shoulder joint (osteoarthritis)
• a rupture of the rotator cuff
• Dislocations in the shoulder joint (dislocation)
• an impingement syndrome
  or
• a chronic frozen shoulder.

therapy

The treatment of acute subacromial bursitis consists primarily of protecting the shoulder joint. It should initially be immobilized as much as possible. In particular, the exercise that is believed to have led to the bursitis should be avoided. In addition, many patients find cooling to be pleasant, as it reduces the inflammatory reaction on the one hand and relieves pain on the other.

Learn more about Treatment with home remedies for bursitis of the shoulder

If the pain cannot be brought under control as a result, the use of medication makes sense. There are a few ways to take medication orally. Painkillers from the group of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or diclofenac, are particularly effective here. Another option is to inject a drug, usually an anti-inflammatory glucocorticoid, directly into the subacromial space.

Physical measures can also be used. Traditionally, those affected are treated with physiotherapy, but massages or TENS can also be useful. For some, acupuncture therapy also produces good healing results.

If all of these conservative therapeutic approaches achieve no or only insufficient improvement in the symptoms, the patient should think about the possibility of an operation together with a doctor and weigh up the advantages and disadvantages. Every operation involves risks, but if it is successful in the case of subacromial bursitis, the person affected can quickly achieve freedom from symptoms that will remain permanent. In such an operation, the bursa is usually removed as part of a minimally invasive procedure.

physical therapy

In the therapy of subacromial bursitis, the main focus is on rest and medicinal pain and inflammation inhibition.
If the drug treatment approaches fail, many orthopedic surgeons immediately resort to surgery and removal of the bursa.

But physiotherapy offers an important alternative in the treatment of bursitis.
Physiotherapy should only be performed when the movements can be performed without severe pain. Otherwise the movements will be performed incorrectly due to the pain and can worsen the disease in an emergency.
As soon as the inflammation has largely subsided and the pain subsides, the joint needs to be moved and exercised before movement restrictions occur.

A first possibility of physiotherapy is TENS, the transcutaneous electrical nerve stimulation. The aim is to use electrical signals on the skin to influence the nerves in the shoulder in such a way that the pain is reduced.
Find out more at: Electrotherapy

Another option is shock wave therapy, whereby external shock waves hit the inflammation and accelerate its healing process.
Read more about this at: Shock wave therapy

In addition, heat and cold therapies as well as massages are used.
In order to maintain and strengthen the joint function, however, physiotherapy exercises are in the foreground.

Here you can find more information about: physical therapy

Exercises

The Exercises with subacromial bursitis with caution and gently are executed.
In order to avoid incorrect loads, the exercises should initially be instructed by a doctor or physiotherapist.
Also a severe pain speaks against exercising of physiotherapy.

First of all, the Shoulder muscles are loosened. This can be achieved by standing up straight, pulling your shoulders up, shaking your arms hanging down limply and swinging them loosely. Tense muscles are a common cause of bursitis.

Loosely raising your arms and swinging, like in a virtual boxing match, also loosens the muscles.
An important exercise for strengthening the daily head and shoulder posture is rolling the shoulders while standing or sitting. To do this, you lift your head, straighten your upper back and pull your shoulders up as high as you can, then move them backwards and let them sag again. Each of these postures should be held for a few seconds.

Important is the Avoid straining and cramping arms excessively.
Especially with Working above your head need many Relaxation breaks should be inserted, in which these relaxation exercises can be performed.

In particular to one already overcome subacromial bursitis stands the Prevention in the foreground.
Teachers, for example, should keep the blackboard as low as possible so that the shoulder is not unnecessarily stressed when writing at the same time.
Sitting activities should always be performed at the correct height. The desk must be at the correct height for the individual. Here, too, the focus is on relaxation exercises and sufficient breaks in prevention.

homeopathy

The use of homeopathic remedies can also be attempted as part of the therapy of subacromial bursitis. The aim of homeopathy is to combat inflammation and pain. Common homeopathic medicines are: Bryonia (bryony) and Apis mellifica (venom of the honey bee) against pain and swelling over the joint, Rhus toxicodendron (climbing poison sumac) against movement pain in the joint and arnica.

radiotherapy

The administration of low-dose X-rays is widely used in medicine. In addition to treating bursitis such as subacromial bursitis on the shoulder, this inflammation or stimulus irradiation can also be used for arthrosis, tennis elbow or heel spur. In several sessions, radiation is applied to the affected body region for a very short period of time, which ideally leads to anti-inflammatory effects and significant pain relief. The irradiation often lasts about 3 weeks, but a treatment result is not infrequently only evident within the following two months after the irradiation.

Osteopathy

Osteopathy is a branch of alternative medicine and deals with certain functional disorders of the musculoskeletal system of the human body. Inflammatory events in the area of ​​the joints, as is the case with subacromial bursitis, often lead to pain-related relieving or poor posture in the trunk area. The treating osteopath can uncover and treat these through certain manual procedures, so that on the one hand pain caused by poor posture can be eliminated and the affected joint is also relieved. In addition, certain movement exercises in osteopathy joints can be kept in their mobility and improved, which is not unimportant, especially in the case of inflammatory diseases, as otherwise the joint can sometimes stick together.

Read more on this topic at: Osteopathy

acupuncture

Like osteopathy, acupuncture is part of alternative medicine. It comes from traditional Chinese medicine and aims to stimulate specific parts of the body through the fine needle pricks and thus influence the body's functions. In the treatment of inflammatory and painful diseases such as subacromial bursitis, targeted acupuncture can lead to a reduction in inflammation and pain relief. However, this procedure should only be carried out by trained specialists. How exactly acupuncture works has not yet been clarified, the individual response to this procedure varies.

You might also be interested in this topic: acupuncture

How Much Can Physiotherapy Help?

Physiotherapy treatment is an important area in conservative therapy for subacromial bursitis. Before resorting to an operation if drug therapy is unsuccessful, physiotherapy should first be considered. In this context, for example, so-called TENS (transcutaneous electrical nerve stimulation) can be used to relieve pain and to reduce inflammation using shock wave therapy. However, the focus is on cold and heat therapies, massages and, above all, movement and strengthening exercises for the shoulder / trunk area in order to maintain and improve mobility and function in the shoulder joint. It is important that any exercises are only carried out if there is relative freedom from pain, as otherwise incorrect execution can occur. A good result can often be achieved through consistent physiotherapeutic training in combination with anti-inflammatory and pain-relieving medication and injections, without the need for an operation.

When is an operation necessary?

Surgery is often used early in the case of bursitis of the shoulder.
Since the bursa plays an important role in protecting the joint and the tendons, should however all conservative therapeutic measures must be exhaustedbefore an operation is performed.
In addition to the drug therapy and Immobilization also Physical therapies, manual therapies and physiotherapy.

The surgery however, should be done when a acute and extremely severe bursitis present that can spread and cause further damage to the joint.
Locked out is the surgery on the other hand, with inflammations that are not physical but infectious are.

forecast

If subacromial bursitis is not discovered and treated in time, it can change from an acute to a chronic form. In such patients, it is difficult to treat the disease without permanent damage remaining.

If, however, this bursitis is treated appropriately at an early stage, the most important thing here is consistent protection of the shoulder joint and the use of anti-inflammatory painkillers, so it can usually be managed well.