What
Are Tendinitis, Bursitis, and Impingement Syndrome of the Shoulder?
These
conditions are closely related and may occur alone or in combination.
If the rotator cuff and bursa are irritated, inflamed, and swollen,
they may become squeezed between the head of the humerus and the
acromion. Repeated motion involving the arms, or the aging process
involving shoulder motion over many years, may also irritate and
wear down the tendons, muscles, and surrounding structures.
Tendinitis
is inflammation (redness, soreness, and swelling) of a tendon.
In tendinitis of the shoulder, the rotator cuff and/or biceps
tendon become inflamed, usually as a result of being pinched by
surrounding structures. The injury may vary from mild inflammation
to involvement of most of the rotator cuff. When the rotator cuff
tendon becomes inflamed and thickened, it may get trapped under
the acromion. Squeezing of the rotator cuff is called impingement
syndrome.
Tendinitis
and impingement syndrome are often accompanied by inflammation
of the bursa sacs that protect the shoulder. An inflamed bursa
is called bursitis. Inflammation caused by a disease such as rheumatoid
arthritis may cause rotator cuff tendinitis and bursitis. Sports
involving overuse of the shoulder and occupations requiring frequent
overhead reaching are other potential causes of irritation to
the rotator cuff or bursa and may lead to inflammation and impingement.
What
Are the Signs of Tendinitis and Bursitis?
Signs
of these conditions include the slow onset of discomfort and pain
in the upper shoulder or upper third of the arm and/or difficulty
sleeping on the shoulder. Tendinitis and bursitis also cause pain
when the arm is lifted away from the body or overhead. If tendinitis
involves the biceps tendon (the tendon located in front of the
shoulder that helps bend the elbow and turn the forearm), pain
will occur in the front or side of the shoulder and may travel
down to the elbow and forearm. Pain may also occur when the arm
is forcefully pushed upward overhead.
How
Are These Conditions Diagnosed?
Diagnosis
of tendinitis and bursitis begins with a medical history and physical
examination. X rays do not show tendons or the bursae but may
be helpful in ruling out bony abnormalities or arthritis. The
doctor may remove and test fluid from the inflamed area to rule
out infection. Impingement syndrome may be confirmed when injection
of a small amount of anesthetic (lidocaine hydrochloride) into
the space under the acromion relieves pain.
How
Are Tendinitis, Bursitis, and Impingement Syndrome Treated?
The
first step in treating these conditions is to reduce pain and
inflammation with rest, ice, and anti-inflammatory medicines such
as aspirin, naproxen (Naprosyn*), or ibuprofen (for example, Advil,
Motrin, or Nuprin). In some cases the doctor or therapist will
use ultrasound (gentle sound-wave vibrations) to warm deep tissues
and improve blood flow. Gentle stretching and strengthening exercises
are added gradually. These may be preceded or followed by use
of an ice pack. If there is no improvement, the doctor may inject
a corticosteroid medicine into the space under the acromion. While
steroid injections are a common treatment, they must be used with
caution because they may lead to tendon rupture. If there is still
no improvement after 6 to 12 months, the doctor may perform either
arthroscopic or open surgery to repair damage and relieve pressure
on the tendons and bursae.
Reference:
from National Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
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