Shoulder bursitis: injection & recovery

Bursitis shoulder symptoms, cause and treatment. The medical name for an inflammation of the bursa in the shoulder is ‘bursitis’. In shoulder bursitis, the bursa in the shoulder is inflamed, which causes all kinds of complaints. The symptoms of bursitis in the shoulder are pain in the shoulder, with pain that may radiate to the elbow or neck, and (sometimes significant) restrictions in movement. An inflammation does not necessarily mean that the bursa is infected. Bursitis is usually caused by mechanical irritation of the bursa due to overload. The treatment is primarily conservative. It is important for recovery that you continue to use your shoulder, even if you are in pain. This often works better by using painkillers. Sometimes it is necessary to get an injection in the shoulder. Such a syringe inhibits inflammation in the shoulder and reduces pain.

Bursitis of the shoulder

  • What is bursitis?
  • Possible cause of bursitis in the shoulder
  • Complaints and symptoms of bursitis
  • Diagnosis of shoulder bursitis
  • Treatment and recovery of shoulder bursitis
  • Injection
  • Physiotherapy
  • Surgical procedure

 

What is bursitis?

The shoulder joint is a complex joint. The shoulder joint consists of:

  • the head,
  • the bowl,
  • the tendons,
  • the bursa, and
  • the roof of bone.

The head (of the upper arm) forms a joint with the socket of the shoulder blade, and consists of bone with a layer of cartilage. The joint is protected at the top by a kind of roof of bone (the acromion) and the collarbone. The arm is moved with muscles that run between the acromion and the head. In order to allow the muscles to slide smoothly along the roof, a cavity has been designed that is filled with fluid, a so-called bursa. When the bursa is irritated, it swells. Certain movements with the arm will cause the bursa to become pinched more quickly, causing pain.

Pain in shoulder / Source: Istock.com/AndreyPopov

Possible cause of bursitis in the shoulder

Irritation of the bursa can be the result of overload (such as work above the head), or a tear in the muscle, for example as a result of an accident or lifting something. An inflammation does not necessarily mean that the bursa is infected (for example as a result of a wound or bite). Bursitis is usually caused by (mechanical) irritation of the bursa. If there is chronic inflammation, this can almost be traced back to a long-term mild overload of the bursa as a result of frequent and/or increased pressure and/or shearing forces on the bursa. Due to one-sided loads during work or sports, chronic inflammation can develop at some point.

Complaints and symptoms of bursitis

Bursitis often causes the following complaints:

  • local redness, warmth, swelling (sometimes not visible) and pain (where the inflamed bursa is present),
  • pain in the shoulder when lifting and turning the arm,
  • the pain can radiate to the elbow or neck,
  • you may experience pain when lying on the arm (for example during the night, when you sleep),
  • limitation of movements: for example, difficulty raising the arm sideways and sometimes movement is almost impossible.

 

MRI scan / Source: Istock.com/© james steidl

Diagnosis of shoulder bursitis

The GP can often suspect that there is a bursitis based on the description of the complaints. The GP will carry out a physical examination and some tests, as a result of which the complaints may temporarily increase. An x-ray may be taken to rule out other causes. In some cases an MRI scan is necessary.

Treatment and recovery of shoulder bursitis

Bursitis of the shoulder: conservative treatment
The treatment is primarily conservative. In roughly one in three people with shoulder complaints, the complaints disappear within two to six weeks. To promote recovery, it is important to give the area/joint rest and not to strain it. However, this does not mean that the joint must be kept still! Light frequent movements without pain are important to promote recovery. This often works better with painkillers.
A non-sterile infection requires a course of antibiotics.

Injection

If painkillers do not provide sufficient relief and the pain remains very unpleasant, the doctor may decide to give you an injection (under local anesthesia) with analgesic and/or anti-inflammatory fluid. This involves an injection with an adrenal cortex hormone (cortisone injection). An injection in the shoulder can quickly reduce the pain, allowing you to move your arm better, which is beneficial for recovery. The injection works for several weeks and rarely causes side effects. In some cases the pain may increase temporarily, but that is for a few days at most. The worst pain often disappears within two weeks after the injection, after which you can usually use your shoulder reasonably again. However, the complaints can also last longer or come back. If the injection does not help enough, you can receive another injection after two to four weeks. If it turns out that even two injections do not improve the symptoms at all, then a third injection is rarely useful and is therefore often not done.

Physiotherapy

After acute bursitis, the physiotherapist is usually not involved in the recovery. The physiotherapist often intervenes in the case of chronic inflammation.

Surgical procedure

If conservative treatments do not work, the orthopedic surgeon may proceed with surgical intervention via keyhole surgery or an open procedure. Such a procedure creates more space by removing the bursa and/or updating (the underside of) the shoulder roof. After the procedure, you may not use the shoulder for the first 4 to 6 weeks. You must wear the arm in a sling that may only be removed during exercises and in special situations, such as washing the body. After about four weeks, you will start a rehabilitation program with a physiotherapist to help your arm strengthen again. You are not allowed to participate in physical contact sports during the first six months.

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