A bursa is a pocket of tissue which provides a cushion effect between moving tissues around joints.
In the shoulder, there is a bursa between the rotator cuff tendons over the top of the shoulder joint, and the undersurface of the acromion process. This bursa can become inflamed and thickened.
Causes
This may arise as a consequence of trauma or repetitive use of the arm in an elevated position.
When the bursa becomes thickened and inflamed, it can become caught or impinged when the arm is elevated. This can result in significant pain. Patients often complain of generalised pain around the anterior and lateral aspect of the shoulder. The pain may radiate along the upper border of the arm.
With the arm by their side, patients are often reasonably comfortable. On attempting to lift the arm, they experience pain which prevents movement. This will limit overhead activities and can be very debilitating.
Treatment
Non Surgical
Acute cases may be treated with simple analgesia to try and control the pain. In some instances, the inflammation will settle with a period of rest. When the symptoms are failing to subside, a steroid injection may be considered. This is usually injected into or around the bursa, and this gradually reduces the inflammation in the tissue.
Many patients will settle completely with one steroid injection. The effects of the steroid may take several weeks to become apparent. In some situations, a repeat steroid injection may be required to help settle the situation completely.
Surgical
In some cases, patients may continue to have ongoing pain and limitation of shoulder movement despite maximal non-operative treatment. In these situations, consideration can be given to a keyhole procedure. The bursa can be removed arthroscopically. Recovery following the surgery can take several months but most patients will experience a gradual improvement in the range of movement.