The therapy options
Immobilisation of the shoulder joint is suitable as a first therapeutic measure, as the bursa is not stressed even more in this way. Immobilization usually also leads to a reduction in pain, since the bursitis of the shoulder is particularly painful when movements are exerted on the bursa. Cooling the bursa can also help to reduce pain.
Important in the treatment of bursitis of the shoulder is pain therapy, so that no pathological movement patterns are learned. Therefore, the generous use of painkillers is also justified. So-called non-steroidal anti-inflammatory drugs (NSAIDs) are often used for this purpose.
Aspirin, which influences the enzyme cyclooxygenase, and ibuprofen belong to this group of painkillers. When taking aspirin, however, one should ensure that the stomach is properly protected, as this drug also inhibits the production of gastric mucus, which neutralizes stomach acid. Therefore, if you take aspirin permanently, you may experience stomach problems.
The NSAIDs inhibit the production of inflammatory mediators, therefore the inflammation will decrease. Another therapeutic approach is physiotherapy. This can also be used in addition to drug therapy.
During physiotherapy, gentle movement patterns are learned and it is also to be shown how the affected person can avoid movements in the future that promote the development of bursitis of the shoulder.Another possibility is to inject cortisone and its derivatives directly into the bursa affected. These so-called steroids reduce the release of inflammation mediators as well as NSAIDs. The focus is also on reducing the inflammation of the bursa of the shoulder.
However, steroid derivatives are derivatives of the body’s own substances, which makes them fundamentally different from NSAIDs. Surgery is another therapeutic option. This involves the minimally invasive removal of the bursa.
However, this step should only be taken if other therapeutic approaches have not been successful. Although the operation does not cause any symptoms, it does of course carry risks, just like any other operation. For example, after the operation there may be disturbances in wound healing or infections of the surgical wound.
After unsuccessful therapy through immobilization and protection, many orthopedic surgeons take cortisone injections into the shoulder. In the case of severe complaints, a cortisone injection can be an important alternative therapy. Cortisone is a hormone produced naturally in the body, which has an anti-inflammatory effect in therapeutic doses.
This has a positive effect on the inflammation of the bursa. This can thus subside and occasionally even heal. Nevertheless, the cortisone injection is a symptomatic therapy.
If the triggers that led to the bursitis are not treated, the inflammation can recur. Nowadays, cortisone injections are increasingly being replaced by many other, sometimes more sustainable, treatment options. In acute cases, however, it represents an important method of keeping the inflammation in check.
Radiation therapy is also a potential alternative treatment for shoulder bursitis. In particular, it should be considered as a less invasive method before surgery in cases of ineffective previous therapies or recurrent inflammation. In this treatment, the radiation dose is significantly lower than in the treatment of a malignant tumor disease, for example.
Due to the low dosage of the radiation, no extensive tissue damage is to be expected, but rather a scientifically proven anti-inflammatory effect. More than half of those treated describe at least one alleviation of symptoms after radiation. Osteopathy represents an alternative medical direction, which assumes a different basis of origin for diseases of the musculoskeletal apparatus.
According to this approach, all body regions are closely related and complaints occur when imbalances or movement disorders occur in one body region. Osteopathy primarily blames increased tensile and pressure loads as well as tension in the connective tissue fasciae of the shoulder for the development of bursitis of the shoulder. The tense fasciae constrict the anatomical structures and lead to degeneration and discomfort in the long term.
Osteopathic therapy attempts to loosen and relax the fasciae by means of manual interventions and movements. However, the effect of osteopathy is largely unproven and controversial. So-called “kinesiotapes” are nowadays used for therapy and prevention not only for orthopedic diseases but also in numerous other fields.
These are elastic tape bandages that are applied to the skin under tension using certain techniques. In the treatment of bursitis of the shoulder, kinesiotapes can support the joint function and relieve and relax the muscles. In addition, the tape on the skin should improve the blood circulation, lymph drainage and muscle circulation, thereby positively influencing inflammation and providing pain relief.
The effects of Kinesiotape are controversial and not scientifically proven. In sports medicine, the tapes are mainly used in prevention. The tapes can also be applied to the shoulder in case of previous complaints to prevent pain.
Homeopathy is an alternative medical treatment based on medication. Here, active ingredients are only used in such a diluted form that they are no longer chemically detectable. The preparations are intended to stimulate the healing of the disease by transmitting information.
Homeopathic preparations can be used to support acute but also chronic complaints in order to stimulate the self-healing powers of the body. The exact choice of the preparation should be determined by a homeopath.Agents frequently used for inflammation are Silicea terra, the silicic acid or Sticta pulmonaria. The principle of acupuncture in the treatment of bursitis of the shoulder consists of an irritation of certain points of the skin, so-called “meridians”, which should lead to a self-regulation of the body and activation of the self-healing powers.
For this purpose, small needles are pricked into the skin at certain, previously determined sensitive points, which possibly stimulate the release of the body’s own hormones and a healing of acute complaints. There is acupuncture of the entire body or ear acupuncture. The processes that are set in motion by the irritation of the needles are intended to serve both as a causal therapy and to alleviate the symptoms of pain.
The extent of the effect and the exact mode of action of acupuncture are unknown and controversial. Heat and cold can both have positive and negative effects on inflammation. It is important to use them at the right time.
Cold helps especially in acute situations. It reduces blood circulation and metabolism, which is why acutely beginning inflammation, swelling and bleeding can be stopped by the cold. It is generally assumed that cold has positive effects within the first 48 hours after an acute event.
Thereafter, during the healing phase, heat is more likely to be experienced. The heat promotes blood circulation and can help the body to overcome the inflammation by itself. The muscles are also relaxed and supplied with blood by the heat, which allows them to regenerate slowly.