What is shoulder bursitis?

Bursitis of the shoulder joint is an inflammatory lesion of the synovial bursa of the corresponding joint. This disease is treated by:

About the disease

The joint capsule is a narrow cavity filled with synovial fluid. Bursae are formed in those places where the bone structures of the joint approach the skin, performing a delimiting and smoothing function. With the development of the inflammatory process, the synovial tissue begins to produce a large amount of fluid, and at the same time its composition changes. This becomes the morphological substrate for the development of the corresponding symptoms of shoulder bursitis. The disease can be infectious or non-infectious in nature. The main manifestations of bursitis are pain in the shoulder joint, limited mobility and swelling of the skin. In case of infringement of the nerve trunks passing nearby, numbness, a feeling of “crawling goosebumps”, and weakness of muscle strength may develop. The inflammatory process most often involves the subacromial and subdeltoid bursae. Sluggish non-infectious lesions of the shoulder joint bursae most often occur in young people who are at risk of injury to soft tissue formations, for example, during intense sports activities and non-compliance with exercise technique. Considering that the main factor of the disease is chronic injury, miners, loaders, dentists, writers, etc. are at risk. What else causes bursitis? Rheumatological bursitis associated with autoimmune aggression of the body is classified into a separate category. The diagnosis is established on the basis of clinical symptoms and additional examination data, in particular imaging methods (radiography, ultrasound scanning, computed tomography or magnetic resonance imaging). Laboratory tests can determine the activity of the inflammatory process. The list of methods used for the treatment of inflammatory lesions of the bursa of the shoulder joint is quite extensive and is represented by various options for local and general effects. To quickly relieve pain, local therapy is carried out in the form of therapeutic injections of analgesics in combination with glucocorticoids.

Types

• spicy option;
• chronic option.

According to localization, the pathological process can be as follows:

• subacromial;
• subdeltoid;
• subcoracoid.

This localization is determined by which bag is involved in the inflammatory process. If the inflammation affects the area under the deltoid muscle, then they speak of subdeltoid bursitis. If the bursa near the acromial process of the scapula becomes inflamed, then it is subacromial bursitis, and if in the area of ​​the coracoid process, then it is subcoracoid.

Symptoms of shoulder bursitis

The main clinical signs of bursitis may be:

• moderate pain in the joint area;
• limited mobility in the shoulder joint (due to pain);
• redness of the skin over the joint (moderate hyperemia);
• swelling of the skin over the shoulder joint.

The general condition of the patient with bursitis, as a rule, does not suffer. With the development of a purulent process in the joint capsule, a slight increase in body temperature is possible.

When palpating the affected joint, pain and a local increase in skin temperature are determined. When extending and flexing the joint (actively and passively), increased pain is noted.

Timely initiation of treatment helps ensure that the acute process ends in recovery. If therapy is not carried out, the disease becomes chronic. In this case, the pain becomes less pronounced, swelling decreases, hyperemia disappears, and a local tumor of a soft-elastic consistency can be determined, which corresponds to an inflamed bursa. Chronic bursitis is characterized by the appearance of unpleasant sensations during movement in the joint, as well as a limitation in the amplitude of these movements. The patient may be bothered by paresthesia, incl. numbness of the hand. The muscles surrounding the joint reflexively go into spasm.

With the purulent form of bursitis, the clinical signs are more vivid. The patient is concerned about intense pain in the joint of a bursting or jerking nature, increased body temperature and other manifestations of intoxication syndrome. the inflamed joint feels hot, swollen and painful. In a general clinical blood test, the level of leukocytes is increased, the sedimentation of erythrocytes is accelerated, and an increase in the level of neutrophils is noted.

Causes of shoulder bursitis

The causes of shoulder bursitis may be as follows:

• constant exposure to extremely strong mechanical loads on the joint that exceed its strength limit;
• direct injury to the joint, for example due to an impact, sprain;
• metabolic disorders – uric acid salts in gout can be deposited in the joint capsule, leading to the development of bursitis;
• autoimmune processes in which cells of the immune system begin to attack the soft tissue structures of the joint;
• direct penetration of microorganisms into the joint cavity during open wounds, purulent skin lesions (boils, abscesses), as well as due to the spread of pathogens through the blood and lymph from foci of chronic infection (pyelonephritis, tonsillitis, lymphadenitis, etc.).

With inflammation of the synovial bursa, the synthesis and viscosity of the synovial fluid increases, and therefore the synovial membrane of the bursa thickens. From a practical point of view, it is important to distinguish between infectious bursitis, which is caused by microorganisms, and aseptic bursitis, which is caused by trauma, urate deposition or the development of autoimmune reactions. In the case of the infectious nature of the disease, the main pathogens may be staphylococci and streptococci, Pseudomonas aeruginosa and other pathogens.

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If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

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Bursitis of the shoulder joint is an inflammatory process in one of the mucous bursae (bursae) of the shoulder joint. The mucous bursa provides shock absorption and reduces friction between bones and soft tissues, such as tendons and bone.

Name in Latin: Bursitis subacromialis or Bursitis subdeltoidea, depending on the location of the inflammation.

Other names for the disease: may include “subacromial bursitis” or “subdeltoid bursitis”, and the disease may also be part of shoulder impingement syndrome.

If you experience symptoms such as pain, swelling and limited mobility in the shoulder joint, you should contact your GP. They may refer you to a specialist such as an orthopedic traumatologist or rheumatologist for specialized evaluation and treatment.

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Types of shoulder bursitis

Shoulder bursitis can be classified according to various criteria, including the location of the inflammation, the cause of the disease, and its chronology. Here are some of the types of shoulder bursitis:

1. By localization of inflammation:
   • Subacromial bursitis (Bursitis subacromialis) is an inflammation of the mucous bursa located between the acromion (upper part of the shoulder blade) and the tendon of the muscle that lifts the shoulder.
   • Subdeltoid bursitis (Bursitis subdeltoidea) is an inflammation of the bursa under the deltoid muscle.
2. Due to the occurrence:
   • Traumatic – develops after direct injury, fall or blow.
   • Infectious (septic) bursitis – when an infection enters the mucous bursa, often through a skin cut or bite.
3. In chronological order:
   • Acute bursitis is characterized by an abrupt onset of symptoms following injury or infection.
   • Chronic bursitis – develops over time, often due to constant pressure or repetitive motion, and can lead to thickening of the bursa and fibrosis.

Each type may have its own characteristics in terms of symptoms, treatment and recommendations for recovery. The treatment approach depends on the specific type of bursitis, its cause, and the severity of symptoms.

Causes of shoulder bursitis

Inflammation can be caused by various reasons:

• Injuries. Direct blows or injuries to the shoulder area can lead to acute bursitis.
• Repetitive movements. Regular, repetitive movements of the shoulder, for example during sports (tennis, swimming) or certain types of work (painting, construction), can lead to overload and inflammation of the mucous bursae.
• Age changes. As we age, tissues become less elastic and more susceptible to inflammation.
• Chronic pressure. Prolonged pressure on the shoulder, such as from lying in bed for long periods of time or carrying heavy backpacks, can contribute to the development of bursitis.
• Infections. Infectious bursitis can develop when bacteria enter the bursa, perhaps through a cut or scrape in the skin.
• Systemic inflammatory diseases. Diseases such as rheumatoid arthritis or gout can cause inflammation of the bursae as part of a systemic process.
• Anatomical abnormalities. Abnormal changes in the structure of the shoulder joint or surrounding tissues may increase the risk of developing bursitis.
• Incorrect posture. Prolonged poor posture or poor technique can lead to overload and inflammation in the shoulder joint.

Treatment for bursitis is aimed at eliminating the underlying cause, relieving inflammation and pain, and restoring shoulder function.

Symptoms of shoulder bursitis

Symptoms can vary depending on the degree of inflammation and its duration, but typical signs include:

• Pain. This is usually the first and main symptom. The pain may worsen when you move your arm or press on your shoulder.
• Limitation of movements. Inflammation and pain can make shoulder movement painful and limited, especially when raising the arm up or behind the back.
• Swelling and redness. The area around the shoulder may become swollen and red due to inflammation.
• Warm. The inflamed area may feel warmer than the surrounding tissue.
• Feeling of fullness. Due to the accumulation of fluid in the mucous bursa, patients may feel fullness in the shoulder area.
• Clicking sensation. In some cases, when you move your arm, you may experience a clicking or rubbing sensation inside the joint.
• Pain when lying on the affected side. The pain often worsens when the person lies on the affected shoulder.

If bursitis is caused by an infection, you may experience general signs of infection such as fever and general malaise.

If such symptoms appear, you should consult an orthopedic doctor for diagnosis and appropriate treatment.

If you experience similar symptoms, we recommend that you consult a specialist.
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Diagnosis of shoulder bursitis

Diagnosis usually begins with a history and physical examination performed by your doctor. During the examination, your doctor may use various tests to evaluate pain, swelling, redness, and limitation of movement in your shoulder.

In addition to a physical examination, the following diagnostic methods may be used:

• X-ray pictures. Although an x-ray will not show the bursa, it can be used to rule out other problems such as a fracture or arthritis.
• Ultrasound examination (ultrasound). This method can help determine the presence of excess fluid in the mucous bursa and the condition of the surrounding soft tissue. Magnetic resonance imaging.
• An MRI can provide more detailed images of the soft tissue and may be useful in identifying tendon tears and other possible causes of shoulder pain.
• Aspiration of fluid. If swelling is severe, your doctor may perform a joint puncture, during which a needle is used to remove a sample of fluid from the bursa for further analysis. This can help determine whether bursitis is caused by an infection or other conditions.
• Laboratory blood tests. Sometimes blood tests may be ordered to look for signs of inflammation or infection, such as an elevated white blood cell count or elevated C-reactive protein (CRP).

It is important to remember that an accurate diagnosis may require a multifaceted approach, including evaluation of clinical symptoms, physical examination, and the results of additional tests. Based on the diagnostic results, the doctor will determine the best course of treatment.

Treatment of shoulder bursitis

Treatment for shoulder bursitis depends on its cause and severity. Treatment usually begins with conservative measures and may include:

• Rest and change of activity. Avoiding painful movements helps reduce inflammation.
• Ice. Applying cold to the affected area can help reduce swelling and pain.
• Anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
• Physiotherapy. Developing an exercise program to strengthen your shoulder muscles and improve flexibility may help relieve symptoms.
• Corticosteroid injections. If tenderness and inflammation persist, corticosteroid injections directly into the affected bursa may be given to quickly reduce inflammation.
• Aspiration (puncture) of fluid. In some cases, the doctor may decide to remove excess fluid from the mucous bursa using aspiration.
• Antibiotics. Infectious bursitis requires antibiotics.
• Surgical intervention. In rare cases, when conservative treatment is not effective, surgical removal of the inflamed bursa may be necessary.

It is also important to pay attention to preventing recurrent episodes of bursitis, which includes stretching and strengthening exercises, correcting posture and changing the way you perform repetitive movements to avoid additional irritation of the bursa.

All treatment measures must be agreed with the attending physician, who can select an individual treatment plan based on the specific symptoms and condition of the patient.

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Possible complications

Complications of bursitis can occur if the disease is left untreated or treated incorrectly. These include:

• Chronic inflammation. Constant irritation of the bursa can lead to chronic bursitis, in which symptoms become long-lasting and persistent.
• Calcification of the bursa. Prolonged inflammation can lead to calcium deposits in the bursa, causing more severe and persistent pain.
• Limitation of joint mobility. Pain and inflammation can reduce the mobility of the shoulder joint, making it difficult to perform daily activities.
• Amyotrophy. Prolonged immobilization of the shoulder due to pain can lead to decreased muscle mass and strength.
• Infectious bursitis. If bursitis is caused by an infection and is not treated with antibiotics, the infection may spread to surrounding tissue or into the bloodstream.
• Pinched syndrome. Bursitis can contribute to the development of impingement syndrome, in which the rotator cuff tendons become pinched between the bones of the shoulder joint.

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