Shoulder Pain Bursitis

Many types of trauma injury involve the shoulders, directly or indirectly. There are many examples, such as falls and road traffic accidents. In the case of falls, landing on a hand, elbow, or shoulder will affect the shoulder and other structures. Seat belts in road traffic accidents also involve the shoulders, as does holding the steering wheel at the time of impact. However, many traumas involve the entire body, and changes in mobility in one area affect other areas (see related articles on biotensegrity and adaptation). For example, a lower leg or hip injury could require crutches for an extended period, affecting the shoulders. The author is often surprised at how many people never seek treatment after severe traumas, besides the life-saving skills at A&E at the time of injury. Instead, people can put up with pain and a lack of mobility for months, which can easily lead to the condition becoming chronic and resulting in Persistent Pain. During this time, the body adapts and learns to move differently to avoid pain, allowing one to function normally and tissues to heal to some extent. The adaptations in movement can also affect how tissues heal, and the new ways of moving soon become normal and second nature. Hence, one may not feel the pain of the original injury, but one is not moving in the same way as before the trauma. Such tissue adaptations and mobility changes can gradually cause other issues elsewhere as other tissues adapt to changed movement patterns. All the changes can easily cause extra friction, which can then lead to tissue inflammation and Bursitis.

Various treatment options range from non-invasive hands-on treatment to more invasive forms, including cortisone injections and surgery. It is always worth researching (not on social media) before invasive procedures and of a non-life-saving variety. The author has treated many shoulder injuries and bursitis conditions for over 16 years and found a non-invasive approach to work very well with acute and chronic cases. Such an approach often involves some hands-on treatment and a small number of prescriptive exercises that build on the hands-on work. There may also be a need to alter habits or activities during the recovery process. The process is a joint effort requiring the patient to put in some work, which speeds up recovery and reduces the treatment needed. He has seen cases where surgical intervention was the best option due to other factors (calcific tendinopathy), which was causing Bursitis. Equally, there is nothing that an MSK therapist can do about an infected bursa, as that requires G.P. intervention. The author has only seen one infected bursa to date and referred that to a G.P., who resolved the infection with antibiotics.

There have been considerable advancements in general medicine, which has become exceptionally good at treating severe trauma and successfully keeping people alive. However, such advances in treating common ailments and musculoskeletal conditions are less prevalent. G.P.s have relatively limited treatment options when it comes to many MSK conditions. Often, the possibilities involve rest, pain medication, anti-inflammatories, muscle relaxants, exercises or referral. Referrals usually take the form of Physiotherapy or a visit to a Specialist. Physiotherapists may treat conditions with manual therapy, prescriptive exercises and possibly anti-inflammatories, including Cortisone injections. Specialists may also treat the patient with cortisone injections or surgery. Sadly, many patients or patients can embark on the general medical model approach and end up having to have surgery. However, looking at other options before Cortisone injections and surgery is often worth the effort. Professionals within the same field may approach a problem differently based on training, experience and acquired knowledge. Equally, different professions may look at the same problem differently, resulting in a different outcome. Surgery really should be a last resort. There are many other very effective manual therapy options, though these do not fit into the standard general medicine model. Surgical interventions often look to create space within the affected shoulder joint. Typically, the subacromial bursa (bursectomy) or bone removal from the area creates space.