Subacromial bursitis is a common pathological condition which means the inflammation of periarticular tissues. Quite often the disease is associated with impingement syndrome. The last one, in fact, is the synonym of subacromial bursitis, the disease we are now talking about. The pathogenic basis of shoulder impingement syndrome is the fact that continuous micro-traumas are caused to the muscles and ligaments which are involved in the movement of the shoulder joints. And, as a rule, the inflammatory process involves all muscle groups, not certain fibers. With the course of time, the result of minor inflammatory changes (when a patient can even miss the clinical signs of the disease) can lead to dystrophic changes in the muscular system of the affected shoulder joint. At this stage of shoulder impingement syndrome, there are already the first warning signs of the disease. This is the high time that a patient should visit the doctor to get the right diagnosis and proper treatment.
Talking about periarthritis (subacromial bursitis, in our case), it must be mentioned first of all that this disease manifests itself as an inflammation of periarticular tissues around large joints (capsule, ligaments, surrounding muscles, and tendons). The disease occurs most often in middle-aged and elderly people. Generally speaking, the disease causes the inflammation of shoulder tendons and the rotator cuff, and is extremely widespread. The disease affects men and women with equal frequency. It usually affects only one shoulder. Though bilateral subacromial bursitis occurs in some cases as well.
Subacromial Bursitis Causes
As we have mentioned already, subacromial bursitis develops on the basis of microtrauma of muscle groups. Scientists also discuss the role of autoimmune factors in the occurrence of the disease. It should be noted that the diseases of the shoulder joint itself (such as bursitis) may be the reason for the spread of inflammation not only inside the joint and cause arthritis and shoulder impingement syndrome. Moreover, there may be a reverse transition from the inflammatory focus groups of muscles to the joint capsule (taking into consideration all the pathogenetic mechanisms).
In the majority of cases, subacromial bursitis causes deal most often with the shoulder injury, falling on the shoulder or on the stretched arm. A surgery of breast removal and some diseases of internal organs can contribute to the development of this type of bursitis.
In order to diagnose the disease, modern medicine uses such methods as MRI and ultrasound investigation. These ways are very comfortable for the patients as long as they are non-invasive, they don’t cause pain to the patients and don’t require any additional preparations.
Subacromial Bursitis Symptoms
Depending on the capsule of the shoulder joint, in addition to subacromial, subdeltoid bursitis of the shoulder may occur (that’s when the deltoid muscle is involved into the inflammation process).
The disease can occur in several forms. In case a patient with subacromial bursitis experiences painful feeling for a long period of time (while moving hands), that may indicate some form of chronic disease.
In case we are dealing with mild subacromial/subdeltoid bursitis, the symptoms of the disease form will be as follows:
- weak shoulder pain that appears only when one makes certain hand movements;
- one feels restriction of movement in the joint which makes it impossible to put one’s hands behind one’s back, pull it up, or touch the spine with one’s knuckles;
- severe pain accompanies any attempts to lift the arm or to rotate a straightened arm around its axis, overcoming resistance; there is no pain if one doesn’t try to overcome the resistance.
Without proper treatment for bursitis, a mild form of the disease may progress to acute subacromial bursitis. Such a situation occurs on the average in 60 percent of cases often after an overload or additional injuries. Sometimes this form of the disease occurs by itself. The main subacromial bursitis symptoms of the acute form are as follows:
- sudden pain in the shoulder which shoots up the arm and neck and is constantly growing;
- increased pain at night;
- rotation of the arm around the axis is very difficult, almost impossible while forward movement of the hand is almost painless;
- the patient feels most comfortable when holding the hand bent at the elbow pressed against his or her chest;
- there is a slight swelling on the front of the shoulder;
- sometimes there is a slight fever;
- the patient suffers from insomnia; general condition of the body gets worse.
The acute form of the disease lasts for several weeks. After the combined treatment and therapeutic exercises for subacromial bursitis, patients may feel pain relief and experience partial recovery of shoulder movement.
In about 50 percent of all cases, the disease proceeds into the chronic form. Here are main symptoms of the chronic forms of the disease:
- moderate shoulder pain which does not cause much discomfort;
- periodically, during rotation or certain movements, there appears acute pain in the affected shoulder;
- at night, especially in the morning, patients feel ache in the shoulders which causes insomnia.
The chronic form of the disease can last from several months to several years. Sometimes, the disease disappears on its own. But 30 percent of the patients experience the situation when the disease turns into “frozen shoulder” (adhesive capsulitis of shoulder).
Subacromial Bursitis Treatment
An operating surgeon or a therapist deal with subacromial bursitis treatment. Modern treatment methods allow to eventually get rid of a joint disease of almost any form. Frozen shoulder is the most difficult form to treat.
It is better to find the proper treatment for the disease as soon as possible in order to avoid complications. First of all, the doctor should eliminate the causes of the disease. For instance, if the disease has emerged because of the dislocation of intervertebral joints, the doctors will prescribe manual therapy to eliminate this problem. In disturbed circulation in the arm, as a result of breast surgery or heart attack, the treatment is based on the drugs that improve blood circulation.
Nonsteroidal anti-inflammatory drugs are prescribed when treating the shoulder tendons. In the mild form of the disease, these drugs may be enough to eliminate the problem. Also, if the disease is not severe, doctors apply compresses with bishofite or Dimexidum. Laser therapy has proved to be quite effective in the treatment of subacromial bursitis as well.
When subacromial bursitis is diagnosed, doctors often prescribe periarticular injection of hormone corticosteroids. The course of treatment suggests two or three injections. Experts note that this procedure helps about 80 percent of patients.
Many doctors consider postisometric relaxation (or PIR) to be a very effective means of treatment of the disease. Up to 90 percent of patients with different forms of the disease can be cured with 12-15 treatment sessions. You can significantly accelerate the process of treatment combining PIR with therapeutic massage, laser, and manual therapy. The course of PIR in two or three days after the periarticular injections of corticosteroid hormones will also contribute to the successful treatment of this type of bursitis.
Very often, hirudotherapy is used for the treatment of this disease. The leeches applied to the affected area produce substances that improve the microcirculation. This contributes to a more rapid recovery. Still, sometimes patients have allergies to hirudotherapy. In this case, such method of treatment cannot be used any longer.
The disease in mild or chronic stage is effectively treated with natural remedies. Even with traditional medicine, one can use natural remedies which will help in the healing process. For the treatment of subacromial bursitis with natural remedies, medicinal plants are widely used. People make brews and compresses of these plants. Let us now consider some of the recipes of traditional medicine used to treat this disease.
- Pour ten grams of dried crushed nettle leaves with boiling water. Warm the mixture in a water bath for fifteen minutes. Take one tablespoon of tincture three to four times a day.
- Pour one tablespoon of chopped St. John’s wort with boiling water. Leave the infusion for half an hour. Take a tablespoon of the infusion four times a day.
- Grind five grams of wineberries and add a glass of boiling water. Leave it all for half an hour. Take half a cup twice a day.
- Add a half liter of vodka to fifty grams of marigold. Leave for fifteen days. Rub the affected joint with this tincture.
- Grind a horseradish root. Warm the mash up and wrap it in the gauze. Apply the compress to the affected area of the shoulder.