1. This shows the anatomy of the shoulder joint. Many of its tissues can become inflamed, including the tendons and bursa.
2. This an X-Ray of a shoulder with subacromial impingement with supraspinatus rupture.
3. This is an X-Ray showing bursitis of the shoulder joint
Inflammation
General Issues
The glenohumeral joint, commonly known as the shoulder joint, is a complex joint which provides a lot of the motion necessary for everyday tasks. Even small issues can cause noticeable symptoms including pain and decreased motion. There are many structures in the shoulder that can become inflamed, leading to a variety of issues, including​ subacromial impingement, bursitis, tendonitis, bone spurs, bone bruises, and arthritis. ​
Subacromial Impingement
In the shoulder, impingement occurs when a group of tendons called the rotator cuff rubs against the acromion bone. Using the shoulder a lot can cause the tendons of the rotator cuff to swell, decreasing the joint space, causing the cuff to rub against the acromion, leading to pain, irritation, and inflammation. Shoulder impingement is often a result of overuse, and can be quite painful. Risk factors for shoulder impingement include playing overhead sports, jobs with lots of overhead activity, older age, previous injuries, and structural issues. If you are experiencing pain, weakness, and stiffness at the joint that is present during a variety of overhead activities, you may have shoulder impingement. Shoulder impingement is often associated with conditions like bursitis and tendonitis.
Tendonitis
Shoulder tendonitis is a condition where the tendons of the shoulder are inflamed, causing pain, stiffness, and swelling. Anything that causes the tendons of the shoulder to be pinched by surrounding structures can lead to this condition, from years of overhead activity to acute injuries. The symptoms of this shoulder tendonitis are quite similar to bursitis, another inflammatory condition of the shoulder joint. You may also experience a limited range of motion, tenderness, and night pains with this condition.
If untreated, tendonitis can develop into more serious conditions. It can increase the risk of tendon rupture, and if it continues for months it can lead to tenodesis, which is the chronic degeneration of the tendon. So, diagnosing the cause of shoulder pain can be important to preventing further issues.
Bursitis
Bursitis is the inflammation of the bursa, which are fluid filled sacs that reduce friction and cushion the tissues within a joint. The bursa of the shoulder are called the subacromial bursa, and they cushion the area between the rotator cuff and the acromion (shoulder blade). Individuals that do a lot of repetitive overhead motion are at risk for bursitis, as well as older individuals. Illnesses like diabetes, rheumatoid arthritis, kidney disease, and thyroid diseases are also associated with bursitis.
If you are experiencing pain with movement, stiffness, and swelling of the shoulder joint, you may have this condition. Chronic bursitis is characterized by swelling, while infected bursitis involves more severe symptoms like pain, inflammation, tenderness, fever and swelling spreading throughout the body. Traumatic bursitis can be characterized by the immediate onset of swelling and tenderness.
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Inflammation
Bone Spurs
Osteophytes, also called bone spurs, are smooth, bony projections from bone that form near joints. They often develop over time with the onset of joint damage and arthritis, and result in pain and other symptoms when they impinge on other tissues of the body.
Bone Bruises
Bone bruises happen when an injury causes blood to build up in the bone, causing pain, swelling, bruising, and color change. They can be caused by any kind of injury or arthritis. Individuals that do physically demanding sports or activities or high risk activities are at risk for bone bruises. X-rays are used to rule out the possibility of bone fractures, while MRIs are used to confirm the diagnosis. Rest, icing the bruise, and over the counter pain medications can help relieve pain, while more severe injuries can be treated with a sling or immobilizer. However, you should start a range of motion exercises 7-10 days after immobilization to prevent joint stiffness. Diet modifications like consuming increased amounts of Calcium, Vitamin D, and protein rich food can also help prevent future injuries.
Arthritis
Arthritis means inflammation (itis) of the joint (arthro). It occurs when the cartilage that cushions the ends of bones breaks down. There are over a hundred types of arthritis that can affect any joint in the body, but the three most common types are osteoarthritis, rheumatoid arthritis, and post traumatic arthritis.
Osteoarthritis, also known as “wear and tear” arthritis inflames the joint over time. After years of use, the articular cartilage deteriorates at the joint, causing bone rubs against bone. In rheumatoid arthritis, the immune system targets and harms the articular cartilage. In post traumatic arthritis, arthritis develops after an injury to the knee, from broken bones to meniscus tears.
Treatment
If you have shoulder pain, you may benefit from taking a break from activities that cause pain, icing the joint, or physical therapy. Stretching the shoulder and strengthening the muscles and tendons of the joint can also be helpful. It is also helpful to maintain good posture, as this can keep the shoulders and their tendons in the correct position. Exercises strengthening the muscles of the shoulders, back, abdominal region, and other regions of the body can all help with posture. Check out the “Patient Resources” section of this page to see stretches and exercises for the shoulder, or learn from your doctor or physical therapist.
For pain relief, you can also try over the counter pain medications like Tylenol and Ibuprofen. If more conservative methods of treatment are unsuccessful, you may benefit from a corticosteroid injection or surgery. For more information on these treatments, visit the “Medical Knowledge” section of our website!
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Attributions for Images
1. OpenStax College. “Shoulder Joint”. Wikimedia Commons, 19 May 2013, https://commons.wikimedia.org/wiki/File:914_Shoulder_Joint.jpg.
2. RSatUSZ. “Subacromial Impingement with Supraspinatus Rupture”. Wikimedia Commons, 1 February 2017, https://commons.wikimedia.org/wiki/File:Subacromial_Impingement_with_Supraspinatus_Rupture.jpg.
3. . Lengerke. “Phs-calc”. Wikimedia Commons, 29 June 2010, https://commons.wikimedia.org/wiki/File:Phs-calc.jpg.
