Patients with shoulder pain are most often diagnosed with bursitis or tendinitis of the rotator cuff. Also known as impingement syndrome, bursitis is an inflammation of the bursa that lies between the top of the humerus (arm bone) and the top of the shoulder. Normally, the rotator cuff tendons slide smoothly within this space. In some people, however, the space becomes too narrow and the tendons and bursa become inflamed and thickened, which reduces the space even further.
The shoulder is comprised of three bones and is a “ball in socket” type of joint. The three bones that make up the shoulder are the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The humerus fits in a little pocket in the shoulder blade, creating the “ball in socket” visual. Synovial fluid in the shoulder helps to keep the joint lubricated for easier mobility while strong connective tissue surrounds the joint.
Tendonitis is when the tendons in the rotator cuff become irritated or damaged and bursitis is when the bursa becomes inflamed and swells with fluid making it painful.
Rotator cuff pain is very common when it comes to athletes. Athletes who do more overhead motions, such as swimmers and baseball and tennis players are more susceptible to having rotator cuff problems. However, people who repetitively lift or do overhead activities such as paper hanging, working construction or painting are just as vulnerable. Sometimes there is no real cause as to why it occurs.
Impingement syndrome or bursitis is characterized by shoulder pain that occurs when reaching overhead or sideways. There also may be pain when sleeping at night. Symptoms also include:
Mild pain whether doing an activity or staying at rest.
Pain that radiates from the front shoulder to the side of the arm
Pain when making lifting and reaching motions
Some athletes will experience pain when throwing or serving a ball
Approximately 90 percent of patients with shoulder pain will respond to non-operative treatments like rest, exercise and anti-inflammatory medication. Impingement syndrome or bursitis is often successfully treated by a prescribed physical therapy program, medication and sometimes a steroidal injection. Avoiding overhead activities and taking non-steroidal and anti-inflammatory medicines and some physical therapy may be required if reaching behind your back is difficult. If everything fails, surgery may be required. The surgery is to create space for the rotator cuff and remove the inflamed part of the bursa. It can be done with either an open surgery or arthroscopically.
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