shoulder bursitis treatment

Is surgery ever necessary for shoulder bursitis treatment?
The simple answer to this question is yes, but the caveat is that surgery is rarely needed to treat impingement syndrome. Patients with shoulder bursitis almost always respond to non-surgical treatments. Usually these treatments begin to work quickly with resolution of symptoms over a period of one to three months.
How do I know I'm ready for surgery for shoulder bursitis?Patients who are considering surgery should have attempted nonsurgical treatments for at least 3 to 6 months without improvement in symptoms. The symptoms should be causing difficulty with the patient's activities, and/or interfering with sleep at night.
How is surgery for shoulder bursitis performed?The procedure used in the treatment of shoulder bursitis is called a subacromial decompression.
This is an arthroscopic procedure performed using instruments inserted through small incisions. One of the instruments inserted is a video camera about the size of a pencil. Another instrument called a shaver is inserted through another incision. The shaver is used to remove the inflamed bursa. Once the bursa is removed, the rotator cuff is inspected to look for any signs of a tear.
Depending on the bone above the rotator cuff, a burr may be used to remove some bone to create more space for the rotator cuff tendons. Often there is a bone spur in this region that can pinch against the rotator cuff--thus the name impingement syndrome.

When is a cortisone injection appropriate?

If the symptoms are not adequately treated, the next step is usually a cortisone injection, or steroid shot, into the area of inflammation. If the symptoms are significant, your doctor may opt to perform this cortisone injection on an initial visit. The cortisone injection places medication to treat the inflammation directly in the problem area. The most significant downside is that cortisone injections can weaken tendons, and repeated cortisone injections should be carefully considered.

What is the best shoulder bursitis treatment?

The first step of shoulder bursitis treatment is to decrease the inflammation. This is best done by avoiding the problems that cause inflammation. The best rule of thumb to follow: 'If it causes pain, don't do it!' This includes simple activities such as reaching high objects or reaching behind yourself.
How is shoulder inflammation treated?Inflammation can also be treated with anti-inflammatory medications such as Motrin, Advil, Aleve, Celebrex, or one of many others. These all fall within the category of 'non-steroidal anti-inflammatory medications.' Taken by mouth, these medications help with the inflammation of the tendons and bursa, and also help treat the pain.
Once the initial pain subsides with oral medications, some simple exercises or physical therapy may help you return to normal activities without pain.

These exercises help to strengthen the rotator cuff and help the shoulder move more effeciently. In addition, it is important to avoid activities that irritate the rotator cuff tendons. These include:
Overhead weight lifting (such as military press, etc)
Throwing activities
Sleeping with the arm over or behind your head

The symptoms of shoulder bursitis

What are the symptoms of shoulder bursitis/impingement syndrome?Common symptoms include:
o Pain with overhead activities (arm above head height)
o Pain while sleeping at night
o Pain over the outside of the shoulder/upper arm
Impingement syndrome and a rotator cuff tear are different problems, and although they are related, the treatment is different. Impingement syndrome is a problem of inflammation around the rotator cuff tendons. A rotator cuff tear is an actual tear within the tendons. The best signs that differentiate these problems area the strength of the rotator cuff muscles. Your orthopedic doctor will be able to specifically isolate these muscles to better determine if a rotator cuff tear is present. A MRI can also show the tendons of the rotator cuff and help determine if a tear is present.

Impingement syndrome

Impingement syndrome is a descriptive term of pinching of the tendons and bursa of the rotator cuff between bones. In many individuals with this problem, the shape of their bones is such that they have less space than most others. Therefore, small thickenings of the tendons or bursa can cause symptoms. Often there is an initial injury that sets off the process of inflammation. Thereafter, the problem can be self-exacerbating. Once there is an initial injury, the tendons and bursa become inflamed. This inflammation causes a thickening of these structures. The thickening then takes up more space, and therefore the tendons and bursa become are pinched upon even more. This causes more inflammation, and more thickening of the tendons and bursa, and so on.

Where is the problem that causes shoulder bursitis?

The shoulder is interesting in that several bones, muscles, and ligaments contribute to this complex joint.
Impingement syndrome, or shoulder bursitis, occurs when there is inflammation between the top of the humerus (arm bone) and the acromion (tip of the shoulder). Between these bones lies the tendons of the rotator cuff, and the bursa that protects these tendons.
Normally, these tendons slide effortlessly within this space. In some people this space becomes too narrow for normal motion, and the tendons and bursa become inflamed. Inflammation leads to thickening of the tendons and bursa, and contributes to the loss of space in this location. Eventually, this space becomes too narrow to accommodate the tendons and the bursa, and every time these structures move between the bones they are pinched--this is the impingement.

'shoulder tendonitis'

Many patients seek medical attention for shoulder pain, and a common diagnosis given is 'shoulder bursitis,' or 'shoulder tendonitis.' The doctor will then often state that identifying which of these diagnosis is the true cause of pain is not important because the treatment is the same.
This is true. Shoulder bursitis and rotator cuff tendonitis are all ways of saying there is inflammation of a particular area within the shoulder joint that is causing a common set of symptoms. The best terminology for these symptoms is 'impingement syndrome.' Impingement syndrome occurs when there is inflammation of the rotator cuff tendons and the bursa that surrounds these tendons.

Flip-flops, although in style right now, have no arch support of any kind. Manufacturers are starting to add some arch raise to flip-flops, but even with an arch, they offer no stability for the foot.This means the foot will move when walking, especially at the end of gait when coming off the toes, instead of remaining stable. As a result, blisters or pain on the ball of the foot can develop.Ballet-style flats are just as bad as flip-flops because they also have inadequate foot support.Repeated wearing of any type of shoe without support can lead to plantar fasciitis, which is pain in the arch support system of your foot.

The pain will generally confine itself to the bottom of the heel. Pain will be worse when waking up in the morning or getting up from sitting.It can occur with as little as one day of wearing of non-supportive shoes, and the pain can last for up to a year. Five to 10 percent of patients need surgery to try and correct the problem. For those in the baby boomer age range, it can also lead to a form of chronic tendonitis and pain along the inside of the ankle and foot