Bursitis occurs very frequently in the shoulder joint and is extremely painful. It is often enough to immobilize and rest the arm. If the bursitis does not subside, a visit to the doctor is necessary.
Here you will find further information as well as selected specialists and centers for bursitis of the shoulder.
Bursae (medical term: bursa) play an important role in protecting our joints and keeping them mobile. These cushion-like structures filled with a gel-like tissue fluid, hence the name bursa, are components of our joints and prevent pressure damage. Consequently, bursae ensure that the joint can be moved without friction and remains supple.
Bursae are located wherever there is increased pressure, for example superficially under the skin above the kneecap or on the elbow. These bursae are externally visible when they are inflamed or swollen. However, there are also deeper-lying bursae, for example under bones and within joint structures. These are necessary wherever hard structures meet soft structures and rub against each other during movement.
This is the case in the shoulder joint, for example. Here, the so-called long tendon of the biceps muscle - this is the flexor muscle on the front of the upper arm - runs through the joint and attaches to the edge of the shoulder blade. This tendon can also tear (so-called biceps tendon rupture), which leads to weakness in the flexion of the arm. However, there is also a short tendon of this muscle that does not pull through the joint and therefore maintains the flexion function.
A bursa in the shoulder joint, medically known as the subacromial bursa, protects the bones and tendons from overloading or tearing.
All joints in the body are protected by bursae. © freshidea / Fotolia
Bursae can become inflamed, which is known as bursitis. Bursitis subacromialis, i.e. inflammation of the bursa in the shoulder joint, shows typical signs of inflammation:
The swelling of the bursa severely restricts the tendon's range of motion. As a result, even the slightest movement of the arm often causes severe pain.
The shoulder joint is exposed to constant stress and is therefore susceptible © bilderzwerg / Fotolia
The most common cause of bursitis in the shoulder area is overloading the shoulder joint. It is usually caused by an unaccustomed continuous stimulus . During certain activities, the joint performs the same arm movement countless times, for example when painting a wall or carrying furniture when moving house. As a result, tendons and bones repeatedly slide along the protective bursa cushions.
The constant rubbing irritates the surface of the bursa. This often results in acute inflammation. If the strain continues, it can develop into chronic bursitis, which can last for weeks or even months.
Furthermore
can also cause subacromial bursitis. In rare cases, a bacterial infection is also to blame for bursitis in the shoulder area. This is increasingly observed after joint punctures or arthroscopy, which is why these measures should only be carried out if they are really necessary.
Bursitis in the shoulder usually occurs in middle-aged people. Certain underlying diseases such as
increase the risk of developing bursitis.
Uncomplicated bursitis in the shoulder heals on its own after a few days without the need for special measures or medication. Simply resting and relieving the shoulder joint will lead to success.
If you continue to put weight on the shoulder joint despite the inflammation, the inflammation will probably not improve. There is then a risk that the bursitis will become chronic.
However, immobilization of the shoulder joint using a sling is now often advised against, as this can lead to shrinkage of the joint capsule (especially if used for longer than 3 days). This in turn represents a risk factor for stiffening of the joint and should be avoided at all costs.
As a first measure, it is advisable to cool the shoulder with ice. Cooling counteracts the swelling and alleviates the discomfort. However, never place the cooling pad directly on the skin - otherwise there is a risk of frostbite. Cooling gels and ointments from the pharmacy also serve their purpose.
Heat worsens the symptoms and often leads to a worsening of the condition. You should therefore avoid mud applications, saunas or hot baths if possible.
Painkillers such as paracetamol can help with pain. Initially, it makes sense to take a break from exercise until the initial pain subsides.
Cooling, pain relief and rest: first aid for bursitis © Microgen | AdobeStock
After a few days, the pain and the inflammatory process usually gradually subside. Then it is time to carefully mobilize the shoulder again with special exercises. This is because joints stiffen more quickly than expected if they are not moved for too long.
To do this, grasp the diseased arm and move it upwards, outwards and towards the center of the body in three different exercise units. Perform the movement in such a way that you reach the pain threshold, but not beyond it. Hold this position for a few seconds.
Repeat each exercise unit 5 to 10 times a day.
If there is no significant improvement in the symptoms after 4 - 5 days despite immobilizing the affected arm, you should have the shoulder medically examined. This also applies to conditions following a fall, open wounds and discharge of pus as well as fever and chills.
In addition to a detailed medicalhistory and examination of the shoulder, a clear diagnosis can usually be made. An ultrasound examination and an X-ray may be arranged.
Particularly if you have fallen on your shoulder, these examinations should rule out or confirm injury to joint and bone structures. A magnetic resonance imaging(MRI) scan may also need to be carried out if the ultrasound or X-ray examination reveals any abnormalities.
It is also important to differentiate bursitis from other possible diseases. Osteoarthritis, rheumatism or gout are also associated with similar symptoms. If the result is inconclusive, a blood and urine test may also be ordered, although this is very rare.
Treatment will often initially consist of prescribing anti-inflammatory medication to stop the inflammatory process in the shoulder.
Another treatment option is cortisone injections, which usually relieve the symptoms very quickly. This pain-relieving and anti-inflammatory medication is injected directly into the shoulder joint or bursa. This often leads to a rapid improvement in symptoms. However, cortisone injections should only be used in absolutely exceptional cases. Injections (medically known as punctures) always carry the risk of pathogens (bacteria) being carried into the joint cavity and worsening the overall situation.
In rare cases, extensive fluid deposits accumulate in the bursa as a result of the inflammation. They lead to a clearly palpable swelling. However, if these do not disappear on their own during the healing process, a puncture may be necessary and may be useful and helpful. During the puncture, a thin cannula is used to remove the accumulation of fluid, which quickly reduces the swelling and the symptoms subside very quickly.
Once the inflammatory process has subsided, physiotherapy is recommended to quickly restore full mobility to the shoulder joint.
Sometimes bursitis can persist after 3 - 6 weeks despite medical treatment. Surgery is then considered. Bacterial bursitis or open wounds and externally visible bursitis may also require surgical intervention.
During the operation, part of the bursa and, if necessary, the surface of the bone is smoothed. The procedure is performed in an open operation (using a skin incision) or minimally invasive using the so-called keyhole technique. With minimally invasive surgery, the healing process is usually much faster and only small incisions are required to access the joint cavity.
In principle, the same applies here: Prevention is better than treatment. You can prevent overloading the shoulder joint yourself. A new activity or a new hobby often involves new movements that the body is not used to.
In sports such as tennis or rowing, we perform the same movement over and over again for hours. If these repetitive movements are unfamiliar to us, this places an enormous strain on the shoulder joints.
It is advisable not to overstrain the joints. If possible, always take a few minutes break. This is the only way to give the body the chance to slowly get used to new movement sequences and to withstand stress without damage.
Regular exercise to keep your joints fit also reduces the risk of developing bursitis.
People who move little in everyday life are most susceptible to bursitis. Rusty, immobile joints become inflamed particularly quickly with new, unaccustomed stresses.
But the following also applies to exercise: the dose is crucial, because both too much (= overloading) and too little ("rusting") can be harmful and lead to diseases of the joints and the entire musculoskeletal system. So don't overdo it and be careful with yourself.
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