Shoulder bursitis is an inflammatory process in the synovial bags in the shoulder area. It can be infectious or aseptic, acute, subacute or chronic. It is manifested by pain, restriction of movements and swelling in the shoulder joint. Possible numbness, weakness and increased muscle tone of the affected limb. When infected, symptoms of general intoxication are revealed: high fever, headache, bruising, weakness, chills. To clarify the diagnosis, MRI, CT, ultrasound, radiography and other studies are prescribed. Treatment depends on the form of the disease and can be both conservative and operative.
M75.5 Shoulder bursitis
Shoulder bursitis is an inflammation of one of the synovial bags (burs) located in the shoulder joint area. Usually the subacromial and subdeltoid bags are affected. Chronic aseptic bursitis is mainly observed in young and middle–aged people – athletes and people who, due to their profession, have to intensively load the shoulder joint (loaders, miners, etc.); men suffer more often than women. Infectious bursitis can occur in people of any age and gender. Surgeons treat acute aseptic and infectious bursitis, traumatologists–orthopedists treat chronic aseptic bursitis, and rheumatologists treat bursitis caused by autoimmune diseases.
Shoulder bursitis causes
Most often, aseptic shoulder bursitis develops due to constant overload and repeated microtrauma of the affected area. This disease affects athletes (shot throwers, javelins, etc.), movers, hammers and representatives of other specialties associated with regular weight lifting and repetitive movements in combination with increased stress on the shoulder joint. Sometimes the disease occurs after a single injury (bruise, sprain or tear of ligaments). In gout and some other pathological conditions caused by metabolic disorders, aseptic bursitis is provoked by the accumulation of salts in the wall of the synovial sac. In autoimmune diseases, the aseptic process in the bursa is a reflection of a similar process in the joints.
The cause of infectious bursitis is the penetration of microbial agents into the synovial sac. Pathogens of infection can enter the bursa through direct contact of the bag cavity with the external environment (penetrating wounds), through tissues (superficial wounds, abrasions, pustules in the joint area), through lymphatic pathways (purulent wounds, boils, abscess in the limb area) or with blood flow (common infectious diseases, any purulent processes in the the body). Infectious bursitis can develop both initially and against the background of already existing aseptic inflammation in the synovial sac.
Normally, the bursa is a narrow slit–like cavity with a small amount of fluid produced by the inner shell. It is localized in places where bone protrusions are close to the skin. Protects the skin and underlying tissues from possible injury. There are about 160 such bags in the human body, most of them are located in the area of large and medium joints.
With inflammation, the inner shell of the bursa begins to produce more fluid. The bag increases in size and takes on the appearance of a filled pouch. The composition of the fluid depends on the type of inflammation. With aseptic inflammation, serous exudate accumulates in the bursa, pus forms during infection. Acute purulent or long-existing aseptic process can cause the formation of adhesions, areas of scar tissue, foci of fibrosis and calcification.
Specialists in the field of purulent surgery, traumatology and orthopedics use several systematizations of shoulder bursitis:
- Taking into account the course, acute, subacute and chronic bursitis are distinguished.
- Taking into account the absence or presence of an infectious agent, aseptic and infectious bursitis are distinguished. Infectious bursitis, in turn, are divided into nonspecific (caused by streptococci, staphylococci and other pathogens of nonspecific infections) and specific (provoked by pale spirochete, gonococci, tuberculosis bacillus, etc.).
- Taking into account the nature of the inflammatory fluid, purulent, fibrinous, hemorrhagic and serous bursitis are isolated.
Shoulder bursitis symptoms
Acute aseptic shoulder bursitis is manifested by moderate pain syndrome, mild redness and swelling in the shoulder joint area. The local temperature may be slightly increased. Signs of general intoxication are usually absent, sometimes there is an increase in body temperature to subfebrile figures. Palpation of the affected area is painful, active and passive movements are limited due to pain. Acute bursitis ends with recovery or becomes chronic. With the transition of acute bursitis to chronic pain decreases, hyperemia of the skin and diffuse swelling of soft tissues disappear, local swelling may appear. The patient is concerned about discomfort during movement and rapid fatigue of the limb. In some cases, local numbness occurs. Muscle tone is usually elevated.
Infectious bursitis is characterized by a bright clinical picture. The patient complains of intense twitching or bursting pains, weakness and bruising. The joint is swollen, the skin above it is hyperemic, palpation and movements are sharply painful. Local and general hyperthermia are detected. Chills, headache, nausea and other signs of general intoxication are possible. In the absence of timely adequate treatment, the infection can spread to neighboring organs and tissues, which is fraught with the development of phlegmon, abscess, arthritis of the shoulder joint or osteomyelitis of the humerus.
The diagnosis of shoulder bursitis is made on the basis of clinical signs and data from additional studies. Shoulder x-ray is uninformative and is carried out to exclude other pathological processes. Techniques are used to assess the condition of soft tissues – MRI of the shoulder joint and ultrasound of the shoulder joint. In some cases, a puncture of the bursa is performed with subsequent examination of the punctate. If gout and autoimmune diseases are suspected, a rheumatologist’s consultation is prescribed, if a specific infectious process is suspected, a consultation of a phthisiologist or venereologist is prescribed.
Shoulder bursitis treatment
The treatment regimen depends on the type and characteristics of the course of pathology and may include the following methods: drug therapy, physical therapy, massage, physiotherapy, surgery. To eliminate pain and relieve inflammation in acute and chronic aseptic bursitis, nonsteroidal anti-inflammatory drugs are prescribed. NSAIDs can be used both in tablets for oral administration, and in the form of gels and ointments for topical use. If local remedies are ineffective, a therapeutic blockade of the supra-scapular nerve is carried out.
In case of infectious bursitis, antibacterial therapy is performed. At the initial stage, broad-spectrum antibiotics are prescribed. After examining the fluid obtained during puncture or opening of the bursa, they are replaced with drugs selected taking into account the sensitivity of the pathogen.
With purulent bursitis, surgical intervention is performed – opening and drainage of the bursa. Physiotherapy is prescribed for chronic bursitis, as well as for acute processes after the inflammation subsides. Ultraviolet irradiation, UHF, phonophoresis with hydrocortisone and other steroid preparations, ozokerite, paraffin and ultrasound therapy can be used. Physical therapy is used after the elimination of the inflammatory process to restore muscle strength and the volume of movements in the joint. Exercises are selected individually. Massage is indicated after the inflammation subsides. This method of treatment allows to normalize blood supply to the shoulder joint, improve tissue nutrition and accelerate recovery processes.