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The
shoulder is a ball and socket joint whose articulations
allow for a wide range of motion. This extensive range
of motion allows individuals to participate in a variety
of activities such as throwing, tackling, swinging,
or performing a headstand. However, this wide range
of motion in the shoulder joint occurs at the cost
of decreased stability. As a result, the shoulder
joint is particularly vulnerable to a variety of injuries
such as dislocation, impingement, rotator cuff tear,
arthritis, separation, and bursitis. This article
describes the causes and symptoms of shoulder bursitis
and identifies certain strengthening exercises that
may cause or exacerbate an existing bursitis condition.
The
bursa is a fluid filled sac found in those areas in
the body where friction between tissues might occur.
Bursae are located predominantly between bony prominences,
muscles, or tendons. Their main function is to provide
cushion and support in areas where repetitive motion
occurs. Overuse of muscles or tendons in regions where
bursae are found, as well continuous external compression
or trauma, can cause bursitis. Symptoms include swelling,
pain, and often a loss of muscular strength and range
of motion. Repeated cumulative trauma may eventually
lead to the formation of calcium deposits and to degeneration
of the internal lining of the bursa.
Shoulder
bursitis is a common disorder often seen in athletes
who participate in sports that require repetitive
throwing and swinging motions and who use the shoulder
joint throughout its entire range of motion, such
as in swimming, gymnastics, and wrestling.
There
are several bursae in the shoulder region: the subacromial,
the sub deltoid, the subcoracoid, and the subscapular,
which, as their names imply, lie beneath the acromion,
deltoid, coracoid, and scapula, respectively. In the
shoulder region, there are also bursae beneath the
pectoralis major and in front of and behind the tendons
of the latissimus dorsi. These are filled with synovial
fluid and are located deep within the tendons and
muscles. The main function of the bursae is to facilitate
the gliding of soft tissue structures over bony surfaces.
Although
any of the above mentioned bursae can become irritated,
inflamed, and painful as a result of overuse of or
trauma to the shoulder region, the subacromial bursa
is by far the most frequently afflicted. Irritation
is usually a result of friction, which causes the
lining of the bursa to thicken, thus increasing the
amount of friction and, in some cases, creating a
fold. In turn, this affects the normal gliding movement
of the soft structures over the bony structures of
the shoulder. The condition also makes movement in
the area rougher, sometimes causing a kind of snap,
particularly in abduction and rotation, as the humerus
moves.
The
apparent pathology of shoulder bursitis involving
the subacromial bursa is attributable to a fibrous
build-up and to the presence of fluid that accumulates
as a result of the area's constant inflammation. What
is usually referred to as bursitis is typically caused
by abduction and external rotation and characterized
by pain that originates in the subacromial region.
In fact, the injury also involves the musculotendinous
cuff and the biceps' tendon and sheath, and not just
the bursa itself. Pain results when the arm is abducted
laterally through a range of 70 to 110 degrees. The
pain decreases as it continues upward. This pain is
caused by an impingement of the inflamed structure
lying beneath the acromion process and the coracoacromial
arch.
The
symptoms of shoulder bursitis include a limited active
range of motion and pain, especially during shoulder
abduction and internal and external rotation. The
client may also report tenderness upon palpation of
the deltoid and the acromion, and if the condition
has been present for several weeks or longer, muscle
atrophy may be noticeable as well.
A
recommended treatment for shoulder bursitis is applying
superficial heat in the form of moist pads or infrared
rays and deep heat in the form of diathermy or ultrasound;
however, cold pack applications are sometimes more
beneficial than heat treatment, which occasionally
aggravate symptoms. For more serious cases, ultrasound
therapy helps greatly. It is very important to strengthen
the weakened musculature in order to regain long-term
stability.
Therapy
is often important to prevent the onset of a secondary
symptom known as "frozen shoulder," which,
while generally characteristic of older patients,
sometimes occurs in younger and more active individuals.
Frozen shoulder is described as a chronically irritated
shoulder joint that has been improperly or inadequately
cared for. According to D.D. Arnheim in the Modern
Principles of Modern Athletic Training, "Constant,
generalized inflammation causes degeneration of the
tissues in the facility of the shoulder joint, resulting
in extreme limitation of movement." The main
cure for frozen shoulder is a combination of deep
heat therapy, such as ultrasound and mobilization
exercises.
No
matter what type of treatment for shoulder bursitis
is chosen, the ultimate goal is to regain full range
of motion and to prevent adhesions and muscle contractures
from immobilizing the joint. Once range of motion
is regained in the shoulder area, the patient can
begin shoulder exercises to rebuild strength and to
avoid further injury.
Although
shoulder bursitis appears inherent in sports that
emphasize throwing or stroking movements, such as
baseball and swimming, it very often can be avoided
or minimized through proper physical conditioning
and by foregoing exercises that may lead to or worsen
an existing shoulder bursitis condition.
The
following exercises performed in excessive repetition,
with excessively heavy loads and/or in a fast and
uncontrolled manner, may cause symptoms associated
with bursitis of the shoulder: pressing movements
including the bench press, military press, incline
press, decline press, and pushups; behind-the-neck
latissimus pull-downs and behind-the-neck military
or overhead presses; reverse flies performed with
dumbbells or pulleys; clean and jerks; snatches; pec-decks;
and dumbbell flies. All of these exercises involve
a certain amount of shoulder abduction and internal
or external rotation. Because of the potential for
harm that exists if these exercises are executed improperly,
the National Academy of Sports Medicine recommends
that they be done initially under the guidance of
a certified personal fitness trainer.
Dr.
Cady can help to stabilize your shoulder and return
it to a normal state. Once it is more stable, exercises
help to keep your shoulder stable. Dr. Cady had shoulder
bursitis in his left shoulder and 'practiced what
he preached' by using ice, ultrasound and exercises
to stabilize his shoulder. He continues to do exercises
twice weekly, and has had no problems in either shoulder
for 2 years now.
Call
us today at 408-739-2273 for an appointment!
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