Many people seek help from their orthopedist for shoulder pain, and a common diagnosis given is 'shoulder bursitis,' or 'rotator cuff tendonitis.'
Tendonitis or Bursitis?
Shoulder bursitis and rotator cuff tendonitis are different ways of saying there is inflammation of a particular area within the shoulder joint that is causing a common set of symptoms. The proper terminology for these symptoms is 'impingement syndrome.' Impingement syndrome occurs when there is inflammation of the rotator cuff tendons and the bursa that surrounds these tendons. There is a difference between tendonitis and bursitis, but in most cases of impingement syndrome there is a combination of these problems.
Where Is The Problem?The shoulder is a complex joint where several bones, muscles, and ligaments connect the upper extremity to the chest. Impingement syndrome occurs when there is inflammation between the top of the humerus (arm bone) and the acromion (tip of the shoulder blade). Between these bones are the tendons of the rotator cuff, and the bursa that protects these tendons.
Normally, these tendons slide effortlessly within this space--called the subacromial space. In some people this space becomes too narrow for normal tendon motion, and the tendons and bursa become inflamed. Inflammation leads to thickening of the tendons and bursa, and contributes to the lack of adequate room in the subacromial space. Eventually, this space becomes too narrow to accommodate the tendons and the bursa, and every time these structures move between the bones they are pinched--this is why the condition is called impingement syndrome.
Causes of Shoulder BursitisImpingement syndrome is a descriptive term of pinching of the tendons and bursa of the rotator cuff between bones. In many individuals with this problem, the shape of their bones is such that they have less space than others. Therefore, small thickenings of the tendons or bursa can cause symptoms.
Often there is an initial injury that sets off the process of inflammation. Thereafter, the problem can be self-exacerbating. Once there is an initial injury, the tendons and bursa become inflamed. This inflammation causes a thickening of these structures. The thickening then takes up more space, and therefore the tendons and bursa become are pinched upon even more. This causes more inflammation, and more thickening of the tendons and bursa, and so on.
Symptoms of Shoulder BursitisCommon symptoms include:
- Pain with overhead activities (arm above head height)
- Pain while sleeping at night
- Pain over the outside of the shoulder/upper arm
Impingement syndrome and a rotator cuff tear are different problems, and although they are related, the treatment is different. The treatment of impingement syndrome usually begins with some simple steps. In people who do not respond to these simple treatments, surgery may be considered.