Bursitis

Normal Position

• Supraspinatus
• Acromioclavicular Joint
• Greater tuberosity of humerus
• Deltoid
• Subacromial bursa
• Deep wall of the bursa glides medially on the superficial wall and                     
• Inferior recess of the shoulder joint unpleats and becomes taut.
• Triceps (long head)

DEFINITION

Bursitis is frequently secondary to degenerative lesions of the cuff.  The pathology applies to the non-specific inflammation of the bursa which is closed sac lined with a cellular membrane resembling synovium.  The bursa is separate and distinct from the glenohumeral joint and has no connection with it.

MECHANISM OF INJURY

May be secondary to such other rheumatic diseases as rheumatoid arthritis or gout.  Trauma or primary lesions of the rotator cuff or associated structures can lead to an intimate relationship of the walls of the subdeltoid bursa and supraspinatus tendon.  Excessive and repetitive motion causes friction in this location with subsequent bursa irritation and inflammation.

SYMPTOMS

• Local pain and tenderness.
• Restricted motion at shoulder in abduction.
• Increased pain on movement of shoulder.
• Initial attacks localized in vicinity of greater tuberosity.
• Shoulder joint stiffness and ache.

SIGNS

• Upon abduction of the arm, the thickened bursal wall cannot slide under the acromion and so "bunches up" and checks the motion.
• Palpable swollen and peritendinous tissue.
• Palpable bursal tenderness.

X-RAY

The Lateral Scapular View may demonstrate a superior malposition of the humeral head.

 TREATMENT

• Rest and/or restriction of repetitive motions causing bursal friction.
• Manipulation of humeral head inferiorly.
• Daily ice application (20 minutes) followed by active, pain free range of motion.
• Moist heat (chronic stages) morning and evening.
• Physiotherapy modalities.
• Nutritional support.

THERAPEUTIC EXERCISES

• Swinging the arm anteroposteriorly, while in the erect posture with the trunk flexed forward, is one of the best exercises to prevent the occurrence of adhesions from bursitis. Exercises should be started as soon as acute pain subsides.  At the beginning, do each exercise 5 times, mornings and evenings.
• Thera-Ciser Shoulder Series, with emphasis on extension and adduction.