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Shoulder bursitis

What is it?

Bursitis (ber-SEYE-tis) is inflammation (in-flah-MAY-shun) (swelling, redness and pain) of a bursa. A bursa is a fluid-filled sac that acts as a cushion or shock absorber between a tendon and a bone. A tendon is a cord of tough tissue that connects muscles to bones. Normally a bursa has a small amount of fluid in it. When injured, the bursa becomes inflamed and may become filled with too much fluid. Shoulder bursitis, or subacromial (sub-ak-ROH-mee-ull) bursitis, occurs when a bursa in your shoulder becomes inflamed.

Causes: You may have tendinitis (inflamed tendons) and bursitis in your shoulder at the same time. Your bursitis may be part of a problem called shoulder impingement (im-PINJ-ment). This occurs when the rotator cuff (shoulder muscles and tendons) is inflamed and squeezed between the shoulder bones. This can lead to irritation of the bursa. Following are some common causes of shoulder bursitis:

  • An injury of the shoulder or falling on your outstretched arm.
  • Age. Shoulder bursitis is more common in people as they become older.
  • Infection (in-FEK-shun).
  • Overuse of the shoulder in sports such as tennis, swimming and baseball, especially from pitching and throwing. Overuse can happen by doing activities that cause you to raise your arms over your head a lot. These activities include hanging wallpaper and painting.
  • Rheumatoid arthritis (ahr-THREYE-tis). Bony growths on your shoulder bones may rub against and irritate the bursa and tendons.

Signs and Symptoms:

  • You may feel pain when you move your shoulder or raise your arm over your head.
  • You may have aching pain at rest.
  • You may have pain that awakens you from sleep, especially when you turn onto your sore shoulder.
  • You may not be able to move your arm and shoulder as much as usual.
  • Your shoulder and upper arm may be weaker (not as strong) than usual.

Wellness Recommendations:

  • The most important part of treating bursitis is resting your shoulder while the bursa heals. Resting your shoulder as much as possible will decrease swelling and keep the bursitis from getting worse. Your caregiver may tell you to stop or do less of certain sports or activities if they are causing shoulder pain. When the pain decreases, begin normal, slow movements.
  • Ice causes blood vessels to constrict (get small) which helps decrease inflammation. Put crushed ice in a plastic bag or use a bag of frozen corn or peas. Cover it with a towel. Put this on your shoulder for 15 to 20 minutes, three to four times per day. Apply ice for two to three days or as long as you have pain. Do not sleep on the ice pack because you can get frostbite.
  • After two or three days, you may try using heat to decrease shoulder pain and stiffness. Use a hot water bottle, heating pad or warm compress. To make a compress, dip a clean washcloth in warm water. Wring out the extra water and put it on your shoulder for 15 to 20 minutes, three to four times each day. You may try putting heat on your shoulder before you exercise to increase blood flow and decrease stiffness.

Medical Care:

  • Caregivers may put your arm in a sling to keep your arm close to your body with your elbow bent. This will keep your shoulder still and allow the bursitis to heal. Do not put your arm over your head until the bursitis is healed.
  • Antibiotics (an-ti-bi-OT-iks) may be given to fight or prevent infection (in-FEK-shun) caused by bacteria (bak-TEE-ree-ah). Always take your antibiotics exactly as ordered by your caregiver. Keep taking this medicine until it is completely gone, even if you feel better. Stopping antibiotics without your caregiver's OK may make the medicine unable to kill all of the germs.
  • You may use nonsteroidal (non-ster-OID-al) anti-inflammatory (an-tee-in-FLAM-ah-tohr-ee) medicine (NSAIDs) to help decrease pain and inflammation (swelling). Some NSAIDs may also be used to decrease a high body temperature (fever). This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
  • You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may add local anesthesia (an-es-THEE-zah) to the steroids. This medicine helps decrease bursitis pain. After getting the shot, you may feel like your shoulder is healed and that you can return to heavy exercise. Do not exercise your shoulder until your caregiver says it is OK. You could make the bursitis worse if you exercise too soon.
  • Your caregiver may want you to go to physical (FIZ-i-kal) therapy. Physical therapists (THER-ah-pists) may do treatments such as ultrasound or massage to help your bursitis heal faster. Exercises to stretch your shoulder muscles and tendons to make them stronger will be started after the bursitis has healed.
  • Caregivers may use a needle to drain fluid from your shoulder. The fluid may be sent to a lab and checked for signs of infection.
  • You may need surgery to drain or remove the bursa, or to fix other problems in your shoulder. Surgery is usually not needed unless the bursitis is very bad and does not heal with other treatments.

Following are things you can do to help prevent bursitis from returning:

  • Keep pressure off your shoulder. You may be told to avoid lying or sleeping on the shoulder with bursitis. You may be more comfortable sleeping on your back. Also avoid activities that make your shoulder pain worse, such as throwing and overhead reaching and lifting.
  • Start exercising when caregivers say that it is OK. Exercise is important for stretching your muscles and keeping them strong. You may be told to stop doing an activity if you feel any pain.
  • Stretch and warm-up. Always do warm-ups and stretching exercises before working out. Do cool-down and stretching exercises when you are finished. This will loosen your muscles and decrease stress on your shoulders. Rest between workout programs.
  • Keep your shoulder muscles strong by doing special exercises. Having strong arm, shoulder and back muscles can help support your shoulder. Your caregiver can help you plan an exercise program to build up your muscles and keep them strong.
  • Start treatment right away if you feel bursitis pain. Rest your shoulder, use ice treatments and NSAIDs according to your caregiver's instructions.

HOW TO TREAT YOUR SYMPTOMS:

Herbs and Supplements

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs

  • Boswellia (Boswellia s errata) has been used for many years, but has not been studied in people who have bursitis.
  • Capsaicin creams (Capsicum frutescens) from the cayenne pepper, applied to the skin over the affected area, can help pain. Initial applications are irritating but after the first couple of weeks the irritation goes away. Be careful to wash your hands after applying the capsaicin cream so that none ends up near your eyes.
  • Turmeric (Curcuma longa) has been used for many years, but has not been studied in people who have bursitis.
  • Willow (Salix alba) has been used for many years, but has not been studied in people who have bursitis.

Supplements

  • Bromelain has been used, but has not been studied in people with bursitis.
  • DMSO (dimethyl sulfoxide) has been used, but has not been studied in people with bursitis. Using DMSO longer than 14 days may cause eye problems. Do not use more than 14 days.
  • D-Phenylalanine has been used, but has not been studied in people with bursitis.
  • Niacinamide has been used, but has not been studied in people with bursitis.

Complementary Therapies

  • Acupuncture decreases bursitis inflammation.

Other ways of treating your symptoms: Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

  • You would like medicine to treat bursitis.
  • Your symptoms have not gone away or improved by these self-help measures.
  • Your pain and swelling increase.
  • You have new, unexplained symptoms.
  • You have a fever.
  • You have questions about what you have read in this document.

Care Agreement: You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. Anon. Impingement syndrome. Milton S. Hershey Medical Center. February 27, 2004. Available at: http://www.hmc.psu.edu/healthinfo/i/impingementsyndrome.htm (cited 6/1/04). 2. Anon. Shoulder impingement (bursitis, tendinitis). American Academy of Orthopaedic Surgeons. April 2000. Available at: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=133&topcategory=Shoulder (cited 5/27/04). 3. Ceccherelli F, Gagliardi G, Matterazzo G et al: The role of manual acupuncture and morphine administration on the modulation of capsaicin-induced edema in rat paw: a blind controlled study. Acupunct Electrother Res 1996; 21(1):7-14. 4. Chen AL, Rokito AS, Zuckerman JD. The role of the acromioclavicular joint in impingement syndrome. Clin Sports Med. April 1, 2003; 22(2):343-357. 5. Daya M. Soft tissue conditions: subacromial syndromes and impingement (rotator cuff tendinitis, subdeltoid/subacromial bursitis). In: Marx JA, Hockberger RS, Walls RM, Adams J, Barkin RM, Barsan WG et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed. St. Louis, MO: Mosby; 2002:599-601. 6. Dugan S, Weber K. Selected topics in sports medicine. Dis Mon. September 2002; 48(9):572-616. 7. Mayo Foundation for Medical Education and Research. Bursitis. December 18, 2003. Available at: http://images.mayoclinic.com/invoke.cfm?id=DS00032 (cited 3/2/04). 8. National Institutes of Health. Questions and answers about shoulder problems. National Institute of Arthritis and Musculoskeletal and Skin Diseases and National Institutes of Health Department of Health and Human Services. NIH Publication No. 01-4865. Available at: http://www.niams.nih.gov/hi/topics.shoulderprobs/shoulderqa.htm (5/27/04). 9. Pinter E & Szolcsanyi J: Systemic anti-inflammatory effect induced by antidromic stimulation of the dorsal roots in the rat. Neurosci Lett 1996; 212(1):33-36. 10. Schoen AM: Acupuncture for musculoskeletal disorders. Probl Vet Med 1992; 4(1):88-97. 11. Zhang WY & Li Wan Po A: The effectiveness of topically applied capsaicin: a meta-analysis. Eur J Clin Pharmacol 1994; 46(6):517-522.

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Last Updated: 11/4/2014

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