Introduction
The inflammation of the bursa in the shoulder (bursitis subacrominalis) is a widespread phenomenon especially in middle-aged persons. The bursa forms a sliding layer for the muscles and also separates them from the bones. Since this bursa is stressed by almost every movement in the shoulder, it is also particularly susceptible to pain.
The clinical picture of bursitis in the shoulder makes it relatively easy to distinguish it from other causes of shoulder pain. However, the causes of bursitis are varied and it is important to treat it early so that the inflammation does not become chronic. The bursitis is so painful because the bursa serves as a shifting layer between muscles and bones. If the bursa can no longer perform this task due to inflammation, severe pain occurs.
The symptoms of bursitis
At first there is severe pain in the shoulder. The so-called “painful bow” is particularly noticeable. Patients feel the strongest pain until they have lifted the arm over 90°, after which they can continue to lift the arm without feeling any further pain.
In the case of bursitis in the shoulder, there are also the typical local signs of inflammation such as redness and, in addition to the pain, swelling. These general signs of inflammation are unspecific and may also be caused by another inflammation. The pain in particular should be seen as a warning signal to which the shoulder should be immediately adjusted to avoid major damage.
If the inflammation persists, there is an increased formation of fluid and collagen. Due to the excessive production of collagen, chronic inflammation of the bursa can also lead to stiffening of the joint, although this is rather rare, as the inflammation of the bursa in the shoulder is usually detected early. In contrast, the above mentioned movement pattern is very clear, which is also groundbreaking in diagnostics.
A further symptom is also the restriction of movement, which is mainly caused by the pain. If the inflammation of the bursa remains untreated for a longer period of time, it can lead to atrophy of the shoulder muscles in the long run due to the adopted relieving posture. However, it takes a long time before these symptoms appear.
In most cases, the impairment caused by the pain is so great that the patient will seek help before the muscles start to contract. In order to be able to distinguish an inflammation of the bursa from a rupture of the capsule in the shoulder area, it is also recommended to deal with the following topic: Capsule tear in the shoulderAs a rule, the pain does not occur at rest, but only through slight movements and pressure from outside. When sleeping, however, even small movements or lying on your side can lead to stabbing pain and severely impair your night’s sleep.
In these cases, painkillers such as ibuprofen or diclofenac can be taken for a short time. These reduce the pain and enable a good night’s sleep, which can also contribute significantly to the healing of the inflammation. The inflammation in the shoulder joint can lead to a temporary or permanent loss of strength.
The bursa of the shoulder serves primarily to shield the tendon of the supraspinatus muscle from the bone and to enable its movement under the so-called “acromion“, a part of the acromion. In case of inflammation, the supraspinatus tendon can be irritated and injured. At an early stage, the lateral lifting of the arm, the so-called “abduction“, becomes painful and impossible.
It is usually the first muscular restriction in the case of bursitis of the shoulder. If the inflammation is left untreated, it can in the long term lead to complications of shoulder stiffness and a decline in the shoulder muscles. Here too, long-term loss of strength is to be expected.
For this reason, physiotherapy is recommended at the earliest possible time in order to maintain and strengthen existing movements. In some cases, the very unpleasant symptom of frozen shoulder can occur. As the English term suggests, this is a stiffening of the shoulder joint.
The reason for this is the inflammation of the joint or the bursa of the shoulder, which results in an adhesion.The affected person can neither move the shoulder himself nor let it move passively. Most affected are rotation in the shoulder and abduction, i.e. the lateral lifting of the upper arm. Initially, there is only severe pain in the joint.
Later, the frozen shoulder develops, but the pain subsides. If no improvement is possible with the administration of painkillers and slight passive movement, the joint can be moved vigorously under a short anaesthetic to loosen the adhesions. In the worst case, surgical splitting of the joint capsule may be necessary.
You can find more information about Frozen Shoulder here. The shoulder blade is closely anatomically related to the bursa of the shoulder joint. The scapula has bony protrusions, which are an important muscle attachment point and part of the shoulder joint.
The acromion is also formed by parts of the shoulder blade. The so-called “acromion“, also a part of the shoulder blade, runs above the bursa. For various reasons, such as irritation, incorrect loading or inflammation, structures can become trapped under the acromion and cause pain. The most common change in this area is the “impingement syndrome“, which is clinically very similar to bursitis of the shoulder. In many cases, this pain can be projected onto the scapula via the acromion.