Shoulder impingement and bursitis is caused by inflammation in the space under the shoulder tip which contains some of the rotator cuff tendons. The bursa is a tissue which lubricates and protects the rotator cuff tendons. This is what becomes inflamed. It can be caused by repeated activity, a sudden increase or change in activity or injury, for example starting a new sport or training for an event. It can also occur as part of wear and tear changes in the shoulder tendons that occur as we get older. This is called tendinopathy. As we get older some people develop a bone spur under the shoulder tip, which narrows the space for the rotator cuff tendons. As a result the tendons and bursa rub or impinge on this leading to inflammation.
What are the symptoms of impingement and bursitis?
Shoulder impingement and bursitis often leads to symptoms in the shoulder of pain, loss of movement and or power. Most commonly this is in overhead movements which can lead to difficulty in performing simple day to day tasks such as getting dressed, personal care and chores around the home.
It is commonly associated with wear and tear or inflammation in the acromioclavicular (AC) joint which may produce pain on pushing activities and may mean you experience pain which is worse when you lie on the shoulder.
How do you diagnose impingement and bursitis?
This is typically made clinically from a history and examination, however in most cases plain XRs and either an ultrasound scan or MRI scan may be performed to confirm the diagnosis and establish that there is not tear of the rotator cuff tendons.
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How do you treat impingement and bursitis?
In the first instance, the use of a specific physiotherapy regimen and targeted injection of steroid and anaesthetic is generally the best initial treatment for this condition.
In some cases, the symptoms may improve for a time, but then return or may not respond to non-operative measures. In these circumstances an operation may be recommended which is called a subacromial decompression. This is done as a keyhole or arthroscopic procedure where the bursa and the bone spur are removed. It is a day case operation and typically performed under a general anaesthetic.
If AC joint arthritis or inflammation is present with bursitis, the joint may be excised at the same time.