Shoulder Bursitis & Tendonitis

There is a sack in the top of the shoulder called the bursa. inflammation of the bursa is called bursitis. There are
four muscles that pass from the chest to the upper arm. These muscles form the rotator cuff which moves the
arm. Each of the four muscles attaches to the upper arm by a piece of tissue called a tendon. Inflammation of the
tendon is called tendonitis.

With pure shoulder bursitis and tendonitis, physical exam findings and nerve conduction tests will be negative for
carpal tunnel syndrome. But, it is possible for shoulder bursitis and tendonitis to coexist with carpal tunnel
syndrome.

Pain in the shoulder area can occur with carpal tunnel syndrome and with
cervical radiculopathy (pinched nerve
in the neck). One simple way to distinguish if a person has an intrinsic shoulder problem is to see if there is any
pain associated with shoulder motion. Shoulder motion will cause pain when there is bursitis or tendonitis. But,
there should be not pain with shoulder motion with carpal tunnel syndrome or cervical radiculopathy.

Shoulder bursitis and tendonitis pain will be particularly acute when the arm is raised about shoulder level (eg, as
in abduction where the arm is raised upwards from the side of the body as shown in the diagram below on the
right). In this position, the humeral head (the ball part of the ball and socket of the shoulder joint) approaches the
acromion (the bony roof of the shoulder) causing compression of the bursa and rotator cuff (primarily the
supraspinatus tendon as shown in the drawing below on the left). Resistive testing of the shoulder is painful
especially with rotator cuff tendonitis. Pain with shoulder elevation and resistive testing is generally not present
with carpal tunnel syndrome and cervical radiculopathy.
















A xylocaine (a local anesthetic) injection into the shoulder bursa will usually rapidly decrease bursitis and
tendonitis pain. Such an injection will have no affect on the shoulder pain if it is related to carpal tunnel syndrome
or cervical radiculopathy. A steroid is often mixed in with the xylocaine so it can help to reduce the inflammation
associated with bursitis and/or tendonitis. A general rule of thumb is to limit steroid injections to the shoulder to 3
or 4 in a year. And, it is not a good idea to inject steroid into the shoulder 3-4 times per year for year after year
since this may result in weakening and tearing of the rotator cuff tendon(s).

Treatment for shoulder bursitis and tendonitis includes the use of oral NSAIDs (nonsteroidal anti-inflammatory
drugs) which help to reduce inflammation and pain. Shoulder range-of-motion exercises should be done to
prevent stiffness and the development of a frozen shoulder (a very stiff shoulder resulting from not moving the
shoulder). Physical therapy can often be helpful by providing instruction on shoulder exercises and through the
use of machines such as ultrasound.

MRI scanning can be done in cases where shoulder pain does not improve with the above mentioned
conservative treatment measures. MRI scanning can help to visualize a torn rotator cuff. The rotator cuff is
comprised of four muscles that extend from the chest to the humeral head (the ball of the ball and socket
shoulder joint) and they serve to move the arm. A torn rotator cuff is a common reason for persistent shoulder
pain. Rotator cuff tears can generally be repaired by surgery. Some rotator cuff tears are too large to repair.













































































































In the absence of a rotator cuff tear, 95% of shoulder bursitis/tendonitis will generally resolve within 6 months with
conservative treatment. Surgery can be considered for the 5% or so of people that continue to have shoulder
pain despite 6 months of conservative or nonsurgical treatment. Surgery can be done arthroscopically (using a
small, lighted telescope instrument). A small motorized burr is use to shave off some of the bone from the
undersurface of the acromion in order to "decompress" the underlying bursa and tendon by creating a larger
space. This procedure is called subacromial decompression or acromioplasty. A person should not use the
shoulder for anything strenuous for 6 weeks after surgery. But, shoulder motion exercises are begun right away
after surgery to prevent stiffness. Maximum improvement can take up to 6 months after surgery.

















Qwi
TM Gloves and the Qwi Solution are not beneficial for the prevention or treatment of shoulder bursitis and
tendonitis.

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This is a MRI scan image showing a front
view (ie, coronal view) of a right shoulder. An
intact, normal rotator cuff (supraspinatus)
tendon is present as a thick, black structure
just above the round humeral head. The
black arrow points to this normal rotator cuff
tendon.
This is a MRI scan image showing a side view (ie,
saggital view) of  the same right shoulder shown in the
preceding image directly above this one. The black
arrow points at the intact, normal supraspinatus
tendon. In addition, the rest of the rotator cuff is also
visible as one continuous thick black band around the
top of the humeral head (ie, the round, white structure).
The other three rotator cuff tendons include the
subcapularis (on the front left), the infraspinatus (on
the top, back, right), and the teres minor (on the lower,
back, right).
This drawing shows a simple rotator cuff tear
involving the supraspinatus tendon. Many
tears are more extensive than this.
This is a MRI scan image showing a front view (ie, coronal view) of
a right shoulder. The black arrow points to a large rotator cuff tear
involving the supraspinatus tendon. Notice that the normal, thick,
black tendon just above the humeral head is absent. There is a
white area above the humeral head and this represents fluid
resulting from the rotator cuff tear. The tendon has torn away from
its normal attachment site at about 10 o'clock over the humeral
head. You can see a black structure next to the humeral head at
about 2 o'clock. This represents the retracted end of the torn
supraspinatus tendon.
This is a MRI scan image showing a side view (ie,
saggital view) of  the same right shoulder shown in the
preceding image directly above this one. The black
arrow points to a large rotator cuff tear involving the
supraspinatus tendon. The torn tendon is absent from
its normal location and has been replaced by fluid (the
white area above the humeral head). The
subscapularis tendon is still intact in front of the
humeral head. The tear is so large that it involves at
least part of the infraspinatus tendon . There is even
some signal abnormality (the gray area) involving the
teres minor tendon.
Photograph taken during shoulder
arthroscopy showing a partial tear rotator cuff
tear involving the superior (ie, upper) surface
of the supraspinatus (marked by the black
arrow). The normal tendon should be
smooth and flat. The arthroscope is in the
subacromial bursa space (see anatomical
drawing above for reference).
This is the same area shown in the
photograph above. The partial rotator cuff tear
has been debrided (ie, cleaned up) using the
motorized shaver (the shiny metal object)
seen in the left side of this photo.
The black arrow points to the undersurface of
the acromion after bone has been removed
by the metal burr (the shiny metal tool visible
in the lower left of the photo) as part of the
subacromial decompression procedure.