There are multiple anatomical structures within the shoulder that could be the cause of your shoulder pain and these include the muscles (rotator cuff, biceps, pectoralis major/minor), tendons, bursae, ligaments or bony structures. The picture below shows the majority of these structures, and overall they work together to optimise the function of the shoulder which requires a combination of mobility and stability. The shallow joint structure of the shoulder between the humerus (upper arm bone) and the scapular (glenoid) allows for great mobility however it reduces the stability of the joint which is where the importance of the integration of muscles and ligaments is highlighted. The focus of this blog will be on shoulder pain cause by bursitis.
What are some conditions that cause shoulder pain:
Bursitis – inflammation of the bursae
Tendonitis – Inflammation of the tendon
Muscle strain / tear – Micro damage to a muscle itself which causes pain and inflammation
Ligament sprain – Damage to the ligaments which can cause pain and discomfort
Dislocation / subluxation – Instability as a result of trauma or laxity within the joint that causes a subluxation or dislocation and resulting pain
What is Bursitis:
There are many bursae within the body and they have an important role of lubricating and creating a buffer and smooth surface between a muscle or tendon and a hard surface that it runs over. Within the shoulder there are 5 bursae and they help to lubricate the muscles and tendons as they round the tip of the shoulder and prevent pain and irritation of the tissue. In some cases of overuse and repetitive strain these bursae can become aggravated and inflamed and lead to bursitis. This is characterised by pain symptoms with a painful arc in shoulder flexion between 70-120*, internal rotation and abduction, pain when laying on your side and pain with palpation. You may also have some swelling, redness or warmth felt at the point of inflammation in the shoulder.
What are the symptoms of shoulder Bursitis:
Most simply the symptom of shoulder bursitis is pain, however you may also experience reduced range of motion or shoulder stiffness which needs to be closely monitored to ensure it does not progress to adhesive capsulitis (frozen shoulder). You may observe some swelling, redness and warmth at the shoulder which is a sign of inflammation and aggravation within the joint. The pain characteristics you may experience are the painful arc which is pain felt most specifically between 70-120* of abduction of the shoulder, and also pain with internal rotation and these are two movements which put the most stress on the bursae and if it is inflamed it will be very provocative.
What are the causes of shoulder Bursitis?
Bursitis of the shoulder is most commonly a chronic condition which means that it is developed slowly over time due to consistent overload and stress, however it is possible to have acute bursitis caused by a traumatic incident. When we repeatedly do actions and activities that use the same muscles over and over, the load that goes through the shoulder can become too much and cause an inflammatory response.
Activities include:
Repeated overhead or lifting and carrying work
- Muscles and joints have a certain capacity that they are prepred for and able to comfortably carryout without causing pain. However if we repeatedly do movements with the same muscles and do excess of that they are able to do they can inflame and aggravate the bursa that they are sliding over. This aggravation and inflammation is bursitis.
Sudden increase in activity that invloves shoulder movement
- Similar to the repeated activity above, if you suddenly increase the amount of activity you do with increase repetitions or increase weight and the shoulder is not capable of doing this comfortably it can cause the inflammation within the bursa.
Muscular tension and imbalance that causes in correct loading through the shoulder
With imbalances such as excessive tightness through the chest and pectoral muscles or the posterior shoulder muscles it can impact the mechanics of the shoulder and how the joint moves. This in turn can cause loading changes in the shoulder that can be submaximal and cause overload through tissues such as the bursa and lead to bursitis if the restoration of normal movement is not achieved.
Management of shoulder bursitis:
The management of shoulder bursitis involves a step by step plan of reducing the inflammation, restoring pain free range of motion, introducing and rebuilding pain free strength and then reintegration into high intensity shoulder movements. In addition it is important to determine what caused the overload within the shoulder and address this reason to reduce the likelihood of it happening again.
Reducing inflammation:
To reduce the inflammation in the bursa it is important to avoid the movements that are painful and aggravating, and implement anti inflammatory techniques such as ice and possible anti inflammatories if recommended by your heath care practitioner.
Improve pain free range of motion:
As the symptoms reduce we want to start increasing pain free range of movement in flexion, extension, abduction, internal rotation and external rotation. Working within a pain free range to gradually increase and restore full range of motion in all directions.
Improve pain free strength and exercise capacity
Once we have restored pain free movement you want to start to introduce resistance exercises and gradually increase in strength intensity as the muscles and shoulder adapts to the load.
Increase exposure to more explosive and unplanned out of range movements
The final stage in rehabilitating from bursitis is exposing and increasing the capacity of the shoulder to cope with fast explosive movements and unplanned reactive movements. This is the final stage as you must ensure the shoulder has full range and strength to cope with the stress of fast and unplanned movements without getting aggravated.
Services at RIGS that can help with shoulder bursitis:
Specialised Cryotherapy
- The specialised cryotherapy provides a strong anti inflammatory effect in a specific target area. It allows you to specifically target the cold benefits over the bursa to impact the inflammation most effectively. Usually recommend a consistent 5-7 days of specialised cryotherapy for approx 3-4 minutes to get on top of the inflammation
Contrast water therapy
- After a run of specialised cryotherapy, transitioning to the contrast hot and cold pools to continue to reduce any remaining inflammation in the cold pool, but more importantly reduce tension by submerging in the hot pool. Also within the hot pool it helps to facilitate relaxation and reduction on pain signals and slowly increase pain free movement while in the hot water. Additionally the magnesium within the pools helps with tissue repair and recovery.
Hyperbaric Oxygen therapy
- The hyperbaric oxygen therapy is the ultimate tissue repair and recovery tool. Working by increasing the body's ability to uptake, transport and utilise oxygen within the body, it helps to distribute oxygen to the areas of the body with poorer blood supply to promote healing. Again, consistent use is the key and ultimately the increased healing is most valuable in the early stages - Ideally getting into the chamber 3-5 times per week for 1-2 weeks will be incredibly beneficial to reducing inflammation and initiating healing.
Finally, this process of step by step rehab is very similar for any injuries within the shoulder. Specific exercises for the strengthening can be discussed with your physiotherapist.
If you think you may be battling with shoulder bursitis and would like some assistance with the diagnosis and underlying cause then book in with Krystal our Physiotherapist to get an assessment and treatment plan in place to get you back feeling better ASAP. We hope that this helps you but please remember that everyone is different and to contact your health professional if you are concerned with any pain or symptoms you are experiencing.
Comments