Shoulder bursitis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Shoulder bursitis symptoms
- Diagnostics
- Shoulder bursitis treatment
- Potential consequences and complications
- Forecast
- Prevention
Shoulder bursitis is an acute or chronic inflammation of the bursa (bursa) located in the shoulder joint.
Bursitis of the shoulder joint is diagnosed mainly in men under 35
Bursa is a small anatomical sac-shaped formation, the cavity of which is filled with synovial fluid. Bursae are located in areas of the human body that are subject to mechanical friction during movement, such as over tendons that extend over the ridges of bones. With inflammation, the cells of the inner lining of the synovial bursa begin to synthesize more fluid, as a result of which the bursa increases in volume. The fluid can be serous or purulent, determined by the nature of the inflammatory process. Long-term aseptic or acute purulent inflammation of the tissues of the synovial bag can cause the development of the adhesions, the formation of foci of fibrosis, scar tissue. In addition, calcification of the tissue of the inflamed synovial bag, as well as the surrounding soft tissues,which leads to the formation of calcareous bursitis of the shoulder joint.
Bursitis of the shoulder joint is a widespread pathology. The traumatic form of the disease mainly affects males under 35 years old, especially those who, due to their professional activities, significantly and often load the shoulder joint (miners, loaders, athletes). Infectious bursitis occurs with the same frequency in people of any age and gender.
The subdeltoid or subacromial synovial bag is usually involved in the inflammatory process.
Treatment of bursitis of the shoulder joint is carried out by doctors of various specialties, which is determined by the form of the disease. So, inflammation of the bursa caused by autoimmune processes is treated by rheumatologists. Traumatologists treat patients with aseptic chronic bursitis, and surgeons treat patients with infectious and acute aseptic forms of the disease.
Causes and risk factors
The most common cause of aseptic bursitis of the shoulder joint is prolonged overload of the joint and associated microtrauma. Therefore, it is typical for athletes (javelin throwers, shot throwers), hammer men, blacksmiths, loaders and representatives of other professions, whose work is associated with repetitive hand movements of the same type, lifting weights, and increased loads of the shoulder joint. In some cases, inflammation of the articular bag can develop as a complication of traumatic injury to the shoulder joint as a whole (contusion) or its individual structures (tear or sprain).
Overload of the shoulder joint, microtrauma, rupture and sprain of ligaments can lead to an inflammatory process - bursitis
In some diseases associated with metabolic disorders, salt crystals accumulate in the synovial bag. They damage its walls, thereby provoking the development of an aseptic inflammatory process. An example of such a variant of the pathological process is calcareous bursitis of the shoulder joint, associated with deposits in the synovial bag of calcium salts.
One of the most common causes of shoulder bursitis is autoimmune processes. Under the influence of certain factors, the patient's immune system begins to mistakenly perceive the cells of the synovial membrane as foreign. As a result, she actively attacks them, destroying them, which leads to the development of aseptic inflammation.
Infectious bursitis of the shoulder joint is caused by the penetration of pathogenic microbial flora into the cavity of the synovial bursa. Microbial agents can enter the bursa cavity either as a result of penetrating wounds of the joints, or hematogenous (with blood flow) or lymphogenous (with lymph flow) pathways. Hematogenous and lymphogenous pathways of infection are observed against the background of the following pathological conditions:
- pustular skin diseases (furuncle, carbuncle);
- phlegmon;
- osteomyelitis;
- purulent tonsillitis.
Infectious bursitis can be an independent pathology or a complication of the aseptic process as a result of the addition of a secondary infection.
Forms of the disease
According to the degree of activity of the inflammatory process in the synovial bursa, acute, subacute and chronic forms of bursitis of the shoulder joint are distinguished.
According to the etiological factor, bursitis of the shoulder joint is divided into infectious and aseptic. Infectious, in turn, depending on the type of pathogen, are divided into specific (caused by Koch's bacillus, gonococcus, pale spirochete) and nonspecific (provoked by staphylococci, streptococci, Escherichia coli).
Allocate acute, subacute, chronic bursitis of the shoulder joint
By the nature of the inflammatory fluid accumulating in the cavity of the synovial bag, serous, purulent, fibrous and hemorrhagic forms of bursitis of the shoulder joint are distinguished.
Shoulder bursitis symptoms
The clinical picture of bursitis of the shoulder joint is determined by the form of the disease. In acute aseptic inflammation of the bursa, patients complain of moderate pain in the area of the affected shoulder, edema and redness of the skin over it. In some cases, an increase in local temperature is noted. Symptoms of general intoxication in this form of the disease, as a rule, are absent, and only a small number of patients have an increase in body temperature to subfebrile values. Active and passive movements are difficult due to pain. Palpation of the shoulder joint is painful.
In the absence of the necessary therapy, acute aseptic bursitis of the shoulder joint can become chronic. At the same time, the severity of the pain syndrome decreases, the swelling of soft tissues, hyperemia of the skin disappears. When moving the hand, patients notice discomfort, complain of weakness and rapid fatigue of the affected limb. Muscle tone is increased in most cases. Some patients report local numbness.
The most pronounced symptoms of bursitis of the shoulder joint are manifested in the infectious form of the disease. These include:
- severe pain in the area of the affected shoulder joint (bursting or twitching);
- general weakness;
- weakness;
- lack of appetite;
- headache;
- nausea;
- an increase in body temperature up to 38–40 ° С, accompanied by severe chills;
- severe swelling of the soft tissues surrounding the joint;
- hyperemia (redness) of the skin over the affected joint.
In acute infectious bursitis of the shoulder joint, the patient tries to keep his hand motionless, since any movements (passive, active) are accompanied by strong pain.
Diagnostics
Diagnosis of bursitis of the shoulder joint is carried out on the basis of the characteristic clinical picture of the disease and is confirmed by the data of laboratory and instrumental examination, which includes:
- general blood test - reveals signs characteristic of the inflammatory process (an increase in the number of leukocytes, a shift to the left of the leukocyte formula, an increase in ESR);
- biochemical blood test - in the case of bursitis of the shoulder joint against the background of gout, an increased concentration of uric acid in the serum is revealed;
- bacteriological examination of synovial fluid - with an infectious form of the disease, it allows to identify the pathogen and determine its sensitivity to antibiotics;
- fluoroscopy - due to its low information content, it is used mainly to exclude other pathological processes in the shoulder area;
- magnetic resonance imaging and ultrasound examination of the shoulder joint - allow you to assess the state of the surrounding soft tissues.
Fluoroscopy is one of the methods for diagnosing bursitis of the shoulder charter
Differential diagnosis of bursitis of the shoulder joint is carried out with inflammation of the subcutaneous tissue (cellulitis), osteomyelitis, synovitis, rupture of tendons or muscles.
Shoulder bursitis treatment
The choice of treatment regimen for bursitis of the shoulder joint depends on the form of the disease, the activity of the inflammatory process, the presence or absence of complications.
In acute and chronic aseptic bursitis of the shoulder joint, non-steroidal anti-inflammatory drugs are prescribed, which not only suppress the activity of the inflammatory process, but also have a pronounced analgesic effect. These drugs can be used both systemically (in the form of tablets and injections) and locally (ointments, gels, patches), in some cases, combined use is indicated.
For bursitis of the shoulder joint, NSAIDs in the form of injections can be used to relieve acute inflammation
With long-term aseptic inflammation, a puncture of the affected synovial bag is performed with the introduction of glucocorticoids into it with local anesthetics. If necessary, systemic glucocorticoid therapy can be performed in a short course (no more than five days).
Treatment of infectious inflammation of the bursa of the shoulder joint begins with the appointment of broad-spectrum antibiotics. After receiving the results of bacteriological examination of the synovial fluid, the antibiotic is replaced on the basis of the antibiogram data.
Purulent bursitis of the shoulder joint is an indication for surgical intervention, the essence of which is to open the affected synovial bag, rinse it with antiseptic solutions and install drainage. In the postoperative period, systemic antibiotic therapy is carried out (the introduction of antibiotics into the cavity of the synovial bag is not indicated).
Purulent bursitis of the shoulder joint is an indication for surgery.
After the acute inflammatory process subsides, as well as in chronic forms of bursitis of the shoulder joint, physiotherapy is widely used (paraffin or ozokerite applications, UHF, phonophoresis with hydrocortisone, ultraviolet irradiation).
After relieving pain in order to restore normal muscle tone and range of motion in the affected joint, the patient is recommended to massage and regular exercise therapy. These treatments for shoulder bursitis accelerate recovery by improving blood flow to the soft tissues of the shoulder and stimulating metabolic processes in them.
Potential consequences and complications
In case of untimely treatment of acute infectious bursitis of the shoulder joint, the infectious process can spread to the surrounding tissues, leading to the development of osteomyelitis of the humerus, purulent arthritis, abscess, phlegmon.
Forecast
With timely and adequate treatment of bursitis of the shoulder joint, the prognosis is generally favorable. In most cases, the disease ends with complete recovery. In chronic bursitis, the prognosis is worse, but here, too, correct treatment can achieve remission.
Prevention
Prevention of the occurrence of bursitis of the shoulder joint, first of all, includes measures aimed at preventing shoulder injuries. For this purpose, when performing physical exercises or during work, it is advisable to use special protective equipment (bandages, fixing bandages).
In case of damage to soft tissues in any area of the body, including the shoulder joint, the wound must be washed with an antiseptic solution, treated with iodine tincture of the edges, and then closed with a bandage.
For penetrating wounds, seek medical attention from a surgeon or traumatologist. The doctor will perform the initial surgical treatment of the wound, and, if necessary, prescribe a course of antibiotic therapy, which will reduce the risk of developing infectious bursitis of the shoulder joint.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
