What Are Tendinitis, Bursitis, and Impingement Syndrome of the Shoulder?
Tendinitis, Bursitis and Impingement Syndrome are closely related and may appear alone or together. If the rotator cuff and bursa are irritated, inflamed, and swollen, they may become squeezed between the head of the humerus and the acromion and cause pain. Over many years, repeated motion involving the arms, or the aging process involving shoulder motion, 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 often come with inflammation of the bursa sacs (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
- difficulties 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?
To reduce pain and inflammation with rest, ice, and anti-inflammatory medicines such as:
- aspirin
- naproxen(Aleve, Naprosyn)
- ibuprofen (Advil, Motrin, or Nuprin)
- COX-2 inhibitors
In some cases the doctor or therapist will use ultrasound therapy (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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