Duration
The duration depends strongly on the severity of the inflammation and the triggering factors. If the bursitis appears for the first time in the form of a slight irritation pain after an unusual movement in the shoulder, the duration of the symptoms is often short. If the patient does not exercise, the inflammation can subside within a few days.
If the symptoms are ignored for longer, the duration of the complaints can be prolonged. Despite anti-inflammatory therapy, healing can take several weeks. However, latent inflammation, which occurs due to permanent, e.g. work-related movement, can take a very long time to heal.
The pain can become chronic, persist for months and not respond to conventional therapies. Pain that persists for more than 6 months is often referred to as chronic pain. The reason for chronification is often the fact that the triggering factor of subacromial bursitis is not treated.
Diagnosis of subacromial bursitis
The diagnosis “Bursitis subacromialis” can usually be made simply by taking the patient’s medical history (anamnesis) and a thorough clinical examination. Very typical is the pain when the affected arm is lifted laterally between 80° and 120° (important differential diagnosis here is the impingement syndrome! Various clinical tests that suggest the presence of impingement syndrome, for example the Neer sign or the speed test, can help here).
In case of doubt, an X-ray (in which calcifications become visible), a sonography or an MRI of the shoulder (magnetic resonance imaging of the shoulder) can be carried out additionally. Here the soft tissues such as muscles and ligaments can be visualised well, and any joint effusion can also be detected. Important differential diagnoses (alternative causes) of subacromial bursitis are
- Degenerative changes in the shoulder joint (arthrosis)
- A rupture of the rotator cuff
- Dislocations in the shoulder joint (luxation)
- An impingement syndrome or
- A chronic stiffness of the shoulder.
Therapy
The therapy of acute subacromial bursitis consists mainly of sparing the shoulder joint. It should initially be immobilised as far as possible. In particular, the movement that probably led to the bursitis should be avoided.
In addition, many patients find cooling pleasant, as this reduces the inflammatory reaction on the one hand and relieves pain on the other. If the pain cannot be brought under control, the use of medication is recommended. There are several ways to take medication orally.
Painkillers from the group of non-steroidal 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.
Classically, patients 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 therapy approaches achieve no or insufficient improvement of the symptoms, the patient should consider the possibility of surgery together with a doctor and weigh up the advantages and disadvantages.
Every operation entails risks, but if it is successful in the case of subacromial bursitis, the patient can quickly achieve freedom from symptoms that will remain permanently. In such an operation, the bursa is usually removed as part of a minimally invasive procedure. In the treatment of subacromial bursitis, the main focus is on sparing the patient and inhibiting pain and inflammation with medication.
If the drug treatment approaches fail, many orthopaedic 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 if the movements can be performed without severe pain.
Otherwise, the movements are carried out incorrectly due to the pain and can aggravate the disease in an emergency. As soon as the inflammation has subsided to a large extent and the pain subsides, the joint must be moved and trained before movement is restricted. Another possibility is shock wave therapy, in which mechanical waves from outside are used to hit the inflammation and accelerate its healing process.
In addition, heat and cold therapies and massages are used. However, in order to maintain and strengthen the joint function, physiotherapy exercises are the main focus. The exercises in case of subacromial bursitis must be performed with caution and gently.
In order to avoid incorrect loading, the exercises should initially be instructed by a doctor or physiotherapist. Even severe pain is an argument against the exercise of physiotherapy. The shoulder muscles should first be loosened.
This can be achieved by standing up straight, pulling the shoulders up and shaking the arms hanging limp and swinging them loosely around. Cramped muscles are a common cause of bursitis. Lifting the arms and swinging them loosely, like in a virtual boxing match, also loosens the muscles.
An important exercise to strengthen the everyday head and shoulder posture is rolling the shoulders in a standing or sitting position. This is done by lifting the head, stretching the upper back and pulling the shoulders as high as possible, then moving them back and letting them sink again. Each of these postures should be held for a few seconds.
It is important not to put too much weight on the arms and to avoid cramping them. Especially when working above the head, many relaxation breaks must be taken during which these loosening exercises can be performed. Prevention is particularly important after having already survived subacromial bursitis.
Teachers, for example, should keep the blackboard as low as possible so that the shoulder is not unnecessarily strained when writing at the same time. Sitting activities should always be performed at the correct height. The desk must be at the correct individual height.
Here too, relaxation exercises and sufficient breaks are important for prevention. The use of homeopathic remedies can be tried as a supplement to the therapy of bursitis subacromialis. The aim of homeopathy here is to combat the inflammation and the pain.
Common homeopathic remedies are Bryonia (fence turnip) and Apis mellifica (poison of the honey bee) for pain and swelling over the joint, Rhus toxicodendron (climbing poison sumac) for pain in movement in the joint and Arnica. The administration of low-dose X-rays is widely used in medicine. This inflammatory or even irritant radiation can be used to treat bursitis such as subacromial bursitis of the shoulder, as well as joint arthrosis, a tennis elbow or a heel spur.
In several sessions, radiation is applied to the affected area of the body for a very short period of time, which ideally leads to an inhibition of inflammation and significant pain relief. The radiation often lasts for about 3 weeks, but the results of the treatment often only become apparent within two months after radiation. Osteopathy is a branch of alternative medicine and deals with certain functional disorders of the human body’s locomotor system.
Inflammatory processes in the area of the joints, as is the case with subacromial bursitis, often lead to pain-related posture problems in the trunk area. The treating osteopath can detect and treat these by means of certain manual procedures, so that on the one hand pain caused by bad posture can be eliminated and on the other hand the affected joint is relieved. In addition, certain movement exercises in osteopathy can maintain and improve the mobility of joints, which is particularly important in the case of inflammatory diseases, as otherwise the joint may become sticky.
Acupuncture, like osteopathy, is a branch of alternative medicine. It originates from traditional Chinese medicine and pursues the goal of stimulating certain parts of the body by means of fine needle punctures and thus influencing bodily functions. Even in the treatment of inflammatory and painful diseases such as bursitis subacromialis, acupuncture can lead to a reduction in inflammation and pain. However, this procedure should only be carried out by trained specialists. How acupuncture works has not yet been clarified, the individual response to this procedure varies.