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