Tendinitis,
Bursitis, and Impingement Syndrome
What
Are Tendinitis, Bursitis, and Impingement Syndrome of the Shoulder?
These conditions
are closely related and may occur alone or in combination. If
the rotator cuff and bursa are irritated, inflamed, and swollen,
they may become squeezed between the head of the humerus and
the acromion. Repeated motion involving the arms, or the aging
process involving shoulder motion over many years, may also
irritate and wear down the tendons, muscles, and surrounding
structures.
Tendinitis is inflammation
(redness, soreness, and swelling) of a tendon. In tendinitis
of the shoulder, the rotator cuff and/or biceps tendon become
inflamed, usually as a result of being pinched by surrounding
structures. The injury may vary from mild inflammation to involvement
of most of the rotator cuff. When the rotator cuff tendon becomes
inflamed and thickened, it may get trapped under the acromion.
Squeezing of the rotator cuff is called impingement syndrome.
Tendinitis and impingement
syndrome are often accompanied by inflammation of the bursa
sacs that protect the shoulder. An inflamed bursa is called
bursitis. Inflammation caused by a disease such as rheumatoid
arthritis may cause rotator cuff tendinitis and bursitis. Sports
involving overuse of the shoulder and occupations requiring
frequent overhead reaching are other potential causes of irritation
to the rotator cuff or bursa and may lead to inflammation and
impingement.
What
Are the Signs of Tendinitis and Bursitis?
Signs of these conditions
include the slow onset of discomfort and pain in the upper shoulder
or upper third of the arm and/or difficulty sleeping on the
shoulder. Tendinitis and bursitis also cause pain when the arm
is lifted away from the body or overhead. If tendinitis involves
the biceps tendon (the tendon located in front of the shoulder
that helps bend the elbow and turn the forearm), pain will occur
in the front or side of the shoulder and may travel down to
the elbow and forearm. Pain may also occur when the arm is forcefully
pushed upward overhead.
How
Are These Conditions Diagnosed?
Diagnosis of tendinitis
and bursitis begins with a medical history and physical examination.
X rays do not show tendons or the bursae but may be helpful
in ruling out bony abnormalities or arthritis. The doctor may
remove and test fluid from the inflamed area to rule out infection.
Impingement syndrome may be confirmed when injection of a small
amount of anesthetic (lidocaine hydrochloride) into the space
under the acromion relieves pain.
How
Are Tendinitis, Bursitis, and Impingement Syndrome Treated?
The first step in
treating these conditions is to reduce pain and inflammation
with rest, ice, and anti-inflammatory medicines such as aspirin,
naproxen (Naprosyn*), or ibuprofen (for example, Advil, Motrin,
or Nuprin). In some cases the doctor or therapist will use ultrasound
(gentle sound-wave vibrations) to warm deep tissues and improve
blood flow. Gentle stretching and strengthening exercises are
added gradually. These may be preceded or followed by use of
an ice pack. If there is no improvement, the doctor may inject
a corticosteroid medicine into the space under the acromion.
While steroid injections are a common treatment, they must be
used with caution because they may lead to tendon rupture. If
there is still no improvement after 6 to 12 months, the doctor
may perform either arthroscopic or open surgery to repair damage
and relieve pressure on the tendons and bursae.
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