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Shoulder Tendinitis and Bursitis

Shoulder pain caused by tendinitis and bursitis is very common. The most important step in addressing the problem is determining what structures are affected.

Rotator Cuff Tendinitis and Subacromial Bursitis

Clinically, Rotator Cuff tendinitis, bursitis, and /or impingement may be indistinguishable. The distinction may not be important as treatment is similar.

Pain may develop as the result of a minor injury, over-use, or not infrequently, with no obvious cause. The resulting pain limits motion and may cause apparent weakness. The earliest signs include pain in the outer side of the shoulder and in the upper arm. The patient may not notice any pain in the shoulder area itself, and may instead complain of arm pain. The arm gradually loses the ability to reach behind the back , as well as reaching above the head. Pain may also shoot down the arm, but rarely past the elbow.

A key part of the examination includes checking for arm strength, and looking for other causes of pain. Bursitis pain frequently coexists with, and may mask other problems. Once addressed, the other source(s) of pain may declare themselves and require attention as well.

Treatment The goal of treatment is to reduce pain and restore function.  In the vast majority of cases, nonsurgical treatment is successful. I usually use a combination of injections, physical therapy, and anti-inflammatory medicine. I have found steroid injections to speed up recovery and usually shows effect within a week. Steroid injections also helps as a diagnostic tool. It may take more than one injection to show full effect. Overall, bursitis may take several weeks to resolve, especially if other problems exist. Surgery is rarely needed. Surgery may be needed if there are coexisting problems that require surgical intervention.

I usually do not order advanced imaging unless I suspect a rotator cuff tear or other problems that may require further evaluation or treatment.

Biceps Tendinitis

Biceps tendinitis is frequently mistaken for shoulder bursitis. A typical scenario is that of ‘bursitis’ pain that failed treatment that typically includes steroid injections administered by the primary care provider, physical therapy,  and frequently reffered after an MRI has been ordered. The first question to be answered in this case is whether the pain is truly a ‘bursitis’ pain.

The Biceps muscles has two tendons in the shoulder and are positioned in front of the shoulder. One of them (the Long Head)  passes through a groove along the arm bone.  Irritation of the long head in the groove causes biceps tendinitis.

Biceps tendinitis pain is usually localized to the front of the shoulder. Pain is aggravated by motion, lifting, and reaching.  As described above, biceps tendinitis commonly occurs along with other shoulder problems such as bursitis and arthritis. Sometimes one problems masks the others, but when properly addressed, the less painful ones surface and become more obvious requiring attention as well.

Occasionally, the biceps tendon may spontaneously rupture or dislocate.  A ruptured biceps tendon may cause bruising, weakness, and a bulge of the biceps muscle, frequently called a “Popeye” bulge.

Treatment  The goal of treatment is to reduce pain and restore function.  In the vast majority of cases, nonsurgical treatment is successful. I usually start with a steroid injection, which frequently is all that is needed. Injections usually show effect within a week. Icing, rest, and anti-inflammatory medicines are helpful as well. More than one injection may be required.  It may take more than one injection to show full effect. Overall, pain may take several weeks to resolve, especially if other problems exist. Steroid injections also helps as a diagnostic tool.

Surgery is rarely needed. If deemed necessary, it is usually performed arthroscopically. Classically I perform tenotomy or tenodesis . Tenotomy means cutting the damaged part of the tendon and ‘ let it fly’. Tenodesis means cutting the damaged part and durying the free end into the groove to prevent the muscle from bulging.


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