SUBACROMIAL BURSITIS

WHAT IS SUBACROMIAL BURSAE?

Subacromial bursa is a sac like structure filled with fluid found in the shoulder joint. The subacromial bursa separates the rotator cuff muscles, particularly the supraspinatus muscle from the acromion process (a bony structure), the overlying coracoacromial ligament and deltoid muscle.

The bursa provides a smooth movement of the shoulder joint and reduce friction.

WHAT IS BURSITIS?

Bursitis is the inflammation (irritation) of the bursa. The subacromial bursa is the most commonly inflamed bursa in the shoulder joint. Inflammation of the subacromial bursa becomes a cause of pain in performing activities and movements occurring at shoulder joint. It leads to a restricted movement at the joint due to pain while performing the motion. Hence, a restricted range of motion occurs.

WHAT CAUSES SUBACROMIAL BURSITIS?

·         Injury to the shoulder

·         Overuse of the shoulder joint

·         Calcium deposition

·         Rotator cuff tear

·         Muscle weakness

·         Impingement

·         Joint degeneration

WHAT ARE THE RISK FACTORS?

·         Repetitive injury to the shoulder joint:

The injury is caused due to repetitive movements that occur at causing damage to the shoulder joint.

·         Acute trauma

Any injury due to a fall, or direct hit to the shoulder joint may lead to an inflammation in the

bursa.

·         Overhead lifting movement

The bursa plays an important role in supporting the rotator cuff muscles while performing overhead movements. Frequent overhead movements of the arm leads to an overuse injury to the shoulder joint and associated structures.

-A man hitting the nail with hammer on the wall

-An athlete who is doing an overhead throw of the ball

·         Forceful pulling movement

The movement of frequent forceful pulling leads to overuse and overexertion of the muscle, again 

leading to damage to the shoulder joint.

The movements with the forceful pulling activities may include:

A man pulling heavy weight

A man pulling the rope in tug of war

SYMPTOMS OF THE SUBACROMIAL BURSITIS

There is a gradual onset of the symptoms

1.       PAIN

Burning pain in the shoulder radiating down the arm to elbow and wrist.

Pain worsen on lying on the affected shoulder.

Increased pain on performing movement including overhead activities like washing hair, combing hair, reaching up to the cupboard or shelf.

Pain while performing movements and at rest on the outer side of the shoulder.

2.       RESTRICTED ROM

Pain while performing activities at shoulder joint may lead to a reduced motion, the person suffering from pain may not prefer to perform a movement which is causing an increase in pain and worsening of the condition. Therefore, the movements become restricted.

3.       TENDERNESS

There is a localized palpable tenderness on the anterior (front) and superior (upper) part of the shoulder.

SUBACROMIAL BURSITIS IN DIABETICS AND TREATMENT

Shoulder pain is one of the most commonly experienced pain hampering the day to day life activities. When it comes to shoulder pain, the subacromial bursitis is commonly encountered problem. A person having a history of type II Diabetes when experiences a shoulder pain, the investigations often reveal a subacromial bursitis. patient may complain of the pain on the outer side of the arm just below the acromion on the shoulder. The pain is often dull and will occur more while performing overhead activities. The most commonly affected movements at the shoulder are the flexion (taking the arm up from front), abduction (taking the arm up from side) and internal rotation. The inflamed bursa gets impinged between the joint structures, the head of the humerus and the acromion process. This pain can be relieved by attaining a position in which the two joint surfaces moves apart for example in external rotation. Due to inability of healing the damage and slow repair in diabetic patients, the situation gets worse. As the damage occurring inside the body of the individual is not getting healed. The efficacy of treatment and its results takes much longer time in diabetic patient than in non-diabetics.

Physiotherapy is the best possible treatment and also the preferred treatment in such cases.

At times the result is not satisfactory in diabetic patients due to several pathophysiological reasons going simultaneously in the body.

Corticosteroid injections helps in such cases to a large extent (lidocaine + corticosteroids). The aim here is to reduce pain and improve functions.

Therefore, subacromial steroidal injections along with the physiotherapy management is the best treatment to be followed.

PHYSIOTHERAPEUTIC TREATMENT: (this treatment is followed for diabetics and non- diabetics as well)

ULTRASONIC therapy is given on the tender point: with intensity 1.5 W/Cm for 8 minutes.

TENS (Transcutaneous Electrical Nerve Stimulation): 15 minutes, electrodes on the shoulder and on the distal arm.

 EXERCISES TO BE PERFORMED:

Table Slides (Flexion):  Patient starts with hand on a table (facing the table) put a towel on the table and slide forward. Feel a stretch under your arm. Do 10 repetitions. This exercise is modified for abduction as well.

Table Slides (Abduction):  Patient starts with hand on a table (by the side) put a towel on the table and slide forward. Feel a stretch under your arm. Do 10 repetitions.

Upper Trap: Sit on a table or chair and use the hand of the affected side to grip under the table, (this stabilizes the shoulder). With the opposite hand, pull the head and tilt it to opposite shoulder, feel a stretch in the upper trapezius muscle. Hold for 30 seconds and do 1-3 repetitions twice a day. 

Open Book Stretch: Place a rolled up towel on the couch between the two shoulder blades and lie flat on your back. Keep your arms folded together over the top of your body. Open your arms and then close. Repeat the procedure. Hold for 30 seconds and do 1-3 repetitions twice a day. 

Wall Push Ups: stand in front of the wall and bend your elbows and move toward the wall. Then extend your arms and push the wall as far away as possible without your palms leaving the wall. Repeat 10 times.

Rowing (using a theraband): Sit on a chair. Tie a theraband on a door or a pole, around chest level. Pull the theraband backwards (this pulls shoulder blades together). Do 10 repetitions.

RANGE OF MOTION EXERCISES:

Shoulder wheel

Finger ladder

Shoulder pulley

SHOULDER STRETCH:

Biceps stretch

Triceps stretch

Pectoral stretch

Trapezius stretch

TO PREVENT SUBACROMIAL BURSITIS

Avoid carrying heavy loads.

Avoid too much of overhead activities.

Do not pull heavy objects.