Steroid Injection for shoulder bursitis

What is shoulder bursitis? 

Bursae (plural) are potential fluid-filled sacs that are part of the skeletal system. They cushion the space between bones and connective tissue, allowing tendons, muscle and bone to move together. 

In the shoulder, the subacromial bursae cushion the area between the rotator cuff tendons and the acromion (the highest point of the shoulder blade or scapula). Bursae allow the tendons and bones to glide without friction when you move and lift your arms. 

Injuries or overuse of the shoulder can cause swelling of the bursae. Often the term subacromial bursitis is used to refer to bursitis that affects the shoulder. 

Symptoms:

You may have bursitis if a part of your body, particularly areas close to a joint or directly over a bone, is red or swollen, hot and sore, painful – usually with a dull, aching pain . The area is sensitive and painful if you try to press on or move it, If the bursa is just under your skin, you may also be able to see its outline, because of the swelling inside it. 

Are there different types of bursitis? 

Chronic: 

Injuries or repetitive activities can lead to irritation of the subacromial bursa causing shoulder bursitis. Significant structural injuries such as damaged tendons or irregular or damaged bone may also contribute to irritation of the subacromial bursa leading to recurrent/chronic bursitis. 

Acute: 

This is usually a bursitis of a sudden onset often due to a trauma 

Septic: 

In very unusual and rare cases bursa can become infected which can be related to a skin piercing injury. Usually, the shoulder feels hot and swollen as well as red the pain can be severe 

Common locations of bursitis: 

The most common locations for bursitis are in the shoulder, elbow and hip. However, it can also occur in the knee, heel and the base of the big toe. Bursitis often occurs near            joints that perform frequent repetitive motion.   

Causes: 

Bursitis is caused by inflammation of small fluid pads that overlie areas of strain and stress such as tendons and bones. The normal situation the small pads actually help to make normal movements run very smooth and without any pain and discomfort. However when they become inflamed sometimes due to increased irritation and local stress on the body part they can swell up and become very painful and causing significant impact on normal function. 

How would you know if you have a bursitis?

When as mentioned above you have inflammation of the bursa the bursa might be swollen and painful. This can have a significant impact on the movement of the body part. Pain from the bursitis is usually a dull ache. It can be significantly red and swollen as well. 

Some inflammatory conditions such as rheumatoid arthritis can cause bursitis and another inflammatory conditions such as gout can cause crystals in or around the joints that can cause bursitis as well. 

Often the area where there is strain on tendons such as around the knee the shoulder or the hip can result in bursitis. The underlying source here is usually a tendon which might need treatment which can improve the bursitis. 

 

What treatment can be helpful 

If the pain is quite acute than ice packs on the affected area can be very helpful. Cushioning of the affected area can be helpful. This can be her a foam pad for example or a specific support with padding. 

Physiotherapy can be helpful in particular to address the underlying issues causing the bursitis. Specific exercises and conditioning can help to improve tendon function and reduce bursitis as a result.  

Medication can in some cases be helpful. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful to reduce the most acute pain 

 

What to do if the symptoms do not improve? 

If you have a temperature then do see your GP. If the skin overlying the bursa has been broken then also see your GP. 

If symptoms do not improve but do not have the features as mentioned above (signs of infection) then assessment by a practitioner with specialist musculoskeletal assessment skills would help to diagnose the problem. Examination of the body part should identify the exact problem. A further ultrasound scan would confirm the findings. Sometimes aspiration of the fluid is necessary usually with steroid injection to bring down the local inflammation. 

 

A One-Stop clinic to both diagnose and treat bursitis: 

The fastest and most effective way to manage this problem if the above management strategies have not been effective would be to be seen in a one-stop clinic. 

The Sonoscope diagnostic ultrasound and ultrasound guided injection clinic offers an expert assessment of the body part involved. Diagnostic ultrasound then follows to confirm the diagnosis and following that and after discussion and if appropriate potentially a steroid injection and/or aspiration can be carried out. This would all be done within the one session without the need for any wait and without the need for any extra expenses. 

 

Diagnostic ultrasound and ultrasound guided injections  

When clinical examination reveals that this is a bursitis then ultrasound can help to confirm it and ultrasound will also allow an appropriately skilled specialist to directly target the bursitis with very specific an accurate needle placement to administer the steroid pinpoint accurate in the correct structure. 

 

What is the benefit of an ultrasound guided injection? 

The traditional way in which steroid injections are administered is through landmark guidance, which means using known landmarks to guide needle insertion. To increase accuracy injections are increasingly administered under ultrasound guidance. 

Improved accuracy can reduce the chance of inadvertent needle placement in a neurovascular structure such as an artery or a nerve. This can help to avoid any potential complications. Also increased accuracy of ultrasound guided vs landmark guided injection can improve the outcome of the injection which has been demonstrated in several studies which has been reported by Daniels et al (2018) in their review of the evidence. 

The evidence suggest that ultrasound guidance has better outcomes for the: glenohumeral joint, subacromial bursa and biceps tendon. This was also found by several studies involving the hip and knee. There is evidence that for some conditions more accurate needle placement leads to faster benefit and better pain relief (Sibbitt, 2012). 

 

 

References:

Daniels, E.W., Cole, D., Jacobs, B. and Phillips, S.F., 2018. Existing evidence on ultrasound-guided injections in sports medicine. Orthopaedic journal of sports medicine, 6(2), p.2325967118756576. 

Sibbitt WL Jr, Kettwich LG, Band PA, et al. Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee? Scand J Rheumatol. 2012;41:66-72