okay…pain in my right shoulder, right near the shoulder joint, an aching sensation that worsens with certain overhead activities. definitely a subacromial bursitis/tendinitis, likely from impingement. happened randomly a few weeks ago – awoke one morning with this pain, maybe I slept incorrectly?
I’ve been taking ibuprofen (800mg , three times a day) and resting the shoulder to try and calm down the inflammation. Any other suggestions on ways to speed up the healing process? Very annoying, and it’s interfering with my weight training and other activities. Thanks!
If it’s anterior (as in front of the shoulder) and feels like it’s right below the bony protuberance, it may be a tendinitis in the proximal bicep tendon. I have had a lot of problems with mine, and it took a good deal of muscular manipulation therapy. Ibuprofen will help with the pain and some inflammation, but the causation has to be stopped for the symptoms to disappear.
Hey,
Have you ruled out supraspinatus, subscapularis, biceps tendons on the way to a bursitis diagnosis?
Generally any sub-acromial impingement/inflammation is secondary to either a humeral stabilizer (rotator cuff), or a scapular stabilizer dysfunction, so I would look at those as part of treatment/rehab.
Good luck,
Martin
okay…pain in my right shoulder, right near the shoulder joint, an aching sensation that worsens with certain overhead activities. definitely a subacromial bursitis/tendinitis, likely from impingement. happened randomly a few weeks ago – awoke one morning with this pain, maybe I slept incorrectly?
I’ve been taking ibuprofen (800mg , three times a day) and resting the shoulder to try and calm down the inflammation. Any other suggestions on ways to speed up the healing process? Very annoying, and it’s interfering with my weight training and other activities. Thanks!
this is almost certainly what I called a shoulder impingement syndrome. Caused by some boney projections (from an old injury) from the acromium into the sub acromium space and irritating the rotator cuff everytime you lift your arms. Two diagnostic tools are to inject some local anesthetic (lidocaine) into the subacromial bursa and see if the symptoms go away (you will be able to move your arm without causing symptoms while the anesthetic is there but don’t do it too much as they will get worse from this “excessive” movement after the local wears off). Second is to do an MRI and look for the impingement - it can be very small. If that is what it is it will almost certainly require surgery to correct. There are other potential causes but when you hear hoofbeats first think of horses, not zebras.
stechan-the exact source of shoulder pain can be some times difficult to localize. Although we “Forum Experts” (hah) can give you some general clues, a thorough examination by someone who knows may be your next step. Prior to an MRI, most folks would consider plain x-rays and likely an eval by a physical therapist to see if you can fix the problem with out a lot of fuss. PT’s can be extremely helpful here
The subacromial injection described by Frank Day is both easy and useful, for physician and patient alike. Frequently the bursa (not shoulder joint) is injected with a mixture of local anesthetic and a corticosteroid. (No you won’t test positive for roids at your next race.) Give these simple steps a try and see if you don’t meet with success. Good luck.
stechan-the exact source of shoulder pain can be some times difficult to localize. Although we “Forum Experts” (hah) can give you some general clues, a thorough examination by someone who knows may be your next step. Prior to an MRI, most folks would consider plain x-rays and likely an eval by a physical therapist to see if you can fix the problem with out a lot of fuss. PT’s can be extremely helpful here
The subacromial injection described by Frank Day is both easy and useful, for physician and patient alike. Frequently the bursa (not shoulder joint) is injected with a mixture of local anesthetic and a corticosteroid. (No you won’t test positive for roids at your next race.) Give these simple steps a try and see if you don’t meet with success. Good luck.
Physical exam, of course, is a necessary first step. I injected a lot of sub acromial bursas with local anesthetic (as a diagnostic tool) and steroid (as a therapeutic trial) with the hope of calming things down. I can’t think of a single time this steroid trial (or a trial of physical therapy) ever resulted in avoiding surgery, in anybody who is the least bit active, for the diagnosis I gave.
I can’t think of a single time this steroid trial (or a trial of physical therapy) ever resulted in avoiding surgery, in anybody who is the least bit active, for the diagnosis I gave.
The right kind of physical therapy program can certainly be helpful for a lot of people:
In 1997 Morrison et al . , published a study that reviewed the cases of 616 patients (636 shoulders) with impingement syndrome (painful arc of motion) to assess the outcome of non-surgical care… All patients were managed with anti-inflammatory medication and a specific, supervised physical-therapy regimen. The patients were followed up from six months to over six years. They found that 67% (413 patients) of the patients improved, while 28% did not improve and went to surgical treatment. 5% did not improve and declined further treatment.
I can’t think of a single time this steroid trial (or a trial of physical therapy) ever resulted in avoiding surgery, in anybody who is the least bit active, for the diagnosis I gave.
The right kind of physical therapy program can certainly be helpful for a lot of people:
In 1997 Morrison et al . , published a study that reviewed the cases of 616 patients (636 shoulders) with impingement syndrome (painful arc of motion) to assess the outcome of non-surgical care… All patients were managed with anti-inflammatory medication and a specific, supervised physical-therapy regimen. The patients were followed up from six months to over six years. They found that 67% (413 patients) of the patients improved, while 28% did not improve and went to surgical treatment. 5% did not improve and declined further treatment.
I guess it depends upon what you (or they) mean by “improved”. Unfortunately, physical therapy has absolutely zero tools to undo bone spurs, as far as I know. I presume “improvement” here meant they taught them new ways of avoiding motions that exacerbate the problem (use a stool in the kitchen so one doesn’t have to lift the arm as far to reach shelves). How many of these improved patients were trying to do an triathlon?
Unfortunately, physical therapy has absolutely zero tools to undo bone spurs, as far as I know.
Right, the PT won’t cure the bone spur itself, but this was addressed in the article. The participants in the study were grouped according to what their acromions looked like on x-ray. Those with “Type III” acromions (nasty hook toward the rotator cuff) had the lowest success rate, but still, 64% had a successful result. I’m sure their x-rays still showed the spur, but they didn’t have to have surgery.
How many of these improved patients were trying to do an triathlon?
Well, me, for one. Had impingement syndrome in college, did conservative rehab, and to be honest it took me a long time to get over it. My fastball is not what it once was but I have done triathlons for the last 15 years and I still play the outfield for a softball team. If I do a lot of throwing I can know it’s there but overall it’s good.
Thanks for the tips, folks. I’ve got a pretty good doctor (physiatrist) – the physical therapy route will be focusing on range of motion stretches and strengthening my scapular stabilizing muscles – a lot of impingement comes from a protracted, downwardly rotated scapula. This may be addressed by stretching my pecs; and strengthening my lower/mid trapezius muscles and serratus anterior muscles. That, and doing daily ROM, and taking regular anti-inflammatories.
I’m training for IM AZ in November, so hopefully this will calm down soon to let me continue training!
Hey,
It sounds like your physiatrist and physical therapist know what they are doing, and a good physical exam should rule in/out causes of pain and inflammation. In my opinion, starting to x-ray/MRI/inject the shoulder after a few weeks of impingement symptoms is a waste of health care dollars. These measures may be necessary if the shoulder is unresponsive to conservative treatment, or the orthopedic exam points at structural damage.
IMAZ in November…you got lots of time to get over this, most cases I treat are fully resolved in a matter of weeks.
Martin
Hey,
you got lots of time to get over this, most cases I treat are fully resolved in a matter of weeks.
Martin
I’ve been struggling with shoulder pain since December. I’ve been rehabbing my shoulder ever since. Rotator and subscap work for over 4 months now with PT supervision. I just had an arthrogram last week and it showed subacromial bursitis. Any idea why it would still be inflamed. I haven’t swam since December.
Thanks,