What is a Bursa?

If you have not yet reviewed the general shoulder anatomy page, please do so now. The bursae are pockets of tissue filled with a lubricating substance. Bursae are located wherever two parts of the body come into contact and rub against one another. The purpose of the bursae are to reduce friction and irritation in these areas.

What is Bursitis?

Bursitis literally means inflammation of the bursa. There are many things that can lead to inflammation of the bursa, but the main cause is impingement. In the normal shoulder, there is some rubbing that takes place when the arm is raised. This rubbing, or pinching action is called impingement. Impingement occurs,to some degree,in everyone's shoulder; whenever we do activities with our arm raised above shoulder level. But the real problem occurs in people who work (or play) doing activities that require repetitive throwing or repeatedly raising the arms overhead. This overuse of the shoulder joint can cause irritation and swelling of the bursa. Impingement can also be caused by the development of bone spurs within the shoulder joint. Bone spurs are frequently caused by wear and tear of the A.C. joint.

What are the symptoms of Bursitis/Impingement?

Early symptoms include stiffness and generalized aching of the shoulder joint, pain when raising the arm from the side or the front of the body, and difficulty sleeping due to pain when pressure is put on the affected shoulder. The greatest tell-tale sign of impingement is a sharp pain when reaching toward your back pocket. As the condition worsens, the joint may become stiffer and a "catching" sensation may be felt when the arm is lowered from the front or side of the body. If your arm feels weak or if you are unable to raise the arm, you may have a rotator cuff tear.

How is Bursitis/Impingement diagnosed?

Bursitis/Impingement is best diagnosed through a physical examination by an orthopedist. Your orthopedist will be interested in your line of work and whether your work requires repetitive throwing and/or repetitive action with your arms above your head. X-rays may be taken to ensure that the bony anatomy of your shoulder joint is normal, and to check for bone spurs. An MRI scan may be performed if your orthopedist suspects a tear of the rotator cuff. In some cases pain coming from a problem in the neck can disguise itself as bursitis so your orthopedist may inject a local anesthetic into the bursa. If the pain goes away, your orthopedist will be assured that your pain is coming from the bursa and will continue to treat you for bursitis.

How is Bursitis/Impingement treated?

The best way to treat bursitis is rest, ice, anti-inflammatory medications (such as ibuprofen), and physical therapy to decrease swelling and increase strength and flexibility in the shoulder. In the case of a work-related cause of bursitis, your orthopedist may suggest that you alter how your work is performed to reduce the need for overhead activity.