In our Parnell Physio clinic, we see a lot of patients with shoulder pain and shoulder bursitis. The shoulder is one of the most complex and hardest parts of the body to diagnose. It is such a mobile joint that it is often nearly impossible to narrow down a diagnosis to one exact cause. However, even with this widely accepted fact, the poor shoulder bursa often gets a large amount of the blame. Anyone with shoulder pain is diagnosed with bursitis. Why is this often a poor and inaccurate diagnosis? This will be discussed in this blog by your local Parnell physio, as well as a brief look at a couple of potential other diagnoses.
The bursa is a small fluid sac. It creates a friction free surface to prevent muscles, tendons, ligaments, and other structures rubbing on each other. They are located at and around all large joints. There are over 100 bursae throughout the body.
When aggravated, the bursa can become very inflamed and painful. This is known as bursitis. When imaging is done of the shoulder or other joints, it is one of the first things commented on. People and even health professionals often latch onto it as a diagnosis. More investigation is required to investigate what is causing the bursa to become inflamed. However, some health professionals can become focused on the bursitis and send you away for anti-inflammatories or steroid injections without finding the cause. A quick injection has the chance to relieve the pain, but symptoms can return once the medications wear off. This is because the cause of the bursitis is not addressed. The pain from the bursa should be classified as a symptom. This is a secondary response to what is actually causing it to become aggravated.
One of the most common causes of bursitis is due to rotator cuff dysfunction. This can be due to a tear, weakness, or tendon calcification. The bursa is located in the same region where the rotator cuff tendons run. If the tendon is not functioning as normal, it can put abnormal pressures and loading on the bursa causing it to become inflamed. This can be further aggravated by someone who does a lot of overhead and/or repetitive shoulder loading. Direct trauma is another cause of bursa aggravation. A direct knock onto the shoulder or elbow from a fall or contact from another person or equipment can cause this injury.
Other potential causes of bursitis include auto-immune disorders, infection or medication induced and should not be overlooked when assessing a patient.
The complexity of the shoulder highlights the importance of having a thorough assessment by on of our experienced physiotherapists to ensure the correct diagnosis is found rather than getting lumped into the incorrect diagnosis of bursitis.
The physiotherapists at our Parnell physio clinic will thoroughly examine your shoulder to work out what is causing your pain. Once they have determined what is happening with your shoulder and the shoulder blade, we will design an individualised rehab program for you to work through. Our next blog, from your local Parnell Physio clinic, will describe which exercises are beneficial to help alleviate your shoulder pain and to help offload your bursitis.