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SHOULDER SURGERY GLOSSARY

 

 

 

Bursitis of the Shoulder

What is bursitis?

Bursitis of the shoulder (impingement syndrome) occurs when there is inflammation (swelling and redness) between the top of the arm bone (humerus) and the tip of the shoulder (acromion). Between these bones lie the tendons of the rotator cuff and a fluid-filled sac (the bursa) that protects the tendons. Normally, the tendons slide effortlessly within this space. In some people, this space becomes too narrow for normal motion. This causes irritation to the tendons and bursa, which become inflamed. Inflammation causes the tendons and bursa to swell, making the space for movement still smaller. Eventually, this space becomes too narrow for the tendons and the bursa. Every time they move, they are pinched between the bones. This is the impingement.

What causes bursitis?

  • An injury of the shoulder or falling on your outstretched arm.
  • Age. Shoulder bursitis is more common in people as they become older.
  • Infection (in-FEK-shun).
  • Overuse of the shoulder in sports such as tennis, swimming and baseball, especially from pitching and throwing. Overuse can happen by doing activities that cause you to raise your arms over your head a lot. These activities include hanging wallpaper and painting.
  • Rheumatoid arthritis (ahr-THREYE-tis). Bony growths on your shoulder bones may rub against and irritate the bursa and tendons.

What are the symptoms of bursitis?

  • You may feel pain when you move your shoulder or raise your arm over your head.
  • You may have aching pain at rest.
  • You may have pain that awakens you from sleep, especially when you turn onto your sore shoulder.
  • You may not be able to move your arm and shoulder as much as usual.
  • Your shoulder and upper arm may be weaker (not as strong) than usual

How is bursitis diagnosed?

After discussing your symptoms and medical history, your doctor will examine your shoulder. He or she will check to see whether it is tender in any area or whether there is a deformity. To measure the range of motion of your shoulder, your doctor will have you move your arm in several different directions. He or she will also test your arm strength.

Your doctor will check for other problems with your shoulder joint. He or she may also examine your neck to make sure that the pain is not coming from a "pinched nerve," and to rule out other conditions, such as arthritis.

Imaging Tests

Other tests which may help your doctor confirm your diagnosis include:
X-rays. Because x-rays do not show the soft tissues of your shoulder like the rotator cuff, plain x-rays of a shoulder with rotator cuff pain are usually normal or may show a small bone spur. A special x-ray view, called an "outlet view," sometimes will show a small bone spur on the front edge of the acromion.

Are X-rays or MRIs needed to diagnose bursitis?

Studies such as x-rays and MRIs are not usually needed to make the diagnosis of bursitis. While they are not needed for diagnosis of bursitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays can show evidence of swelling of the bursa, especially in the case of olecranon bursitis. MRIs are also good tests identify swelling, and will show evidence of bursitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed

SURGERY

The goal of surgery is to create more space for the rotator cuff. To do this, your doctor will remove the inflamed portion of the bursa. He or she may also perform an anterior acromioplasty, in which part of the acromion is removed. This is also known as a subacromial decompression. These procedures can be performed using either an arthroscopic or open technique.

Arthroscopic technique. In arthroscopy, thin surgical instruments are inserted into two or three small puncture wounds around your shoulder. Your doctor examines your shoulder through a fiberoptic scope connected to a television camera. He or she guides the small instruments using a video monitor, and removes bone and soft tissue. In most cases, the front edge of the acromion is removed along with some of the bursal tissue.

Your surgeon may also treat other conditions present in the shoulder at the time of surgery. These can include arthritis between the clavicle (collarbone) and the acromion (acromioclavicular arthritis), inflammation of the biceps tendon (biceps tendonitis), or a partial rotator cuff tear.

Open surgical technique. In open surgery, your doctor will make a small incision in the front of your shoulder. This allows your doctor to see the acromion and rotator cuff directly.

PREPARATION

It is important to plan for the post-operative return home prior to the surgery to ensure maximum comfort . For most shoulder surgeries, the procedures can be performed as an outpatient procedure or 1-2 days hospital stay. The shoulder will be immobilized with a sling and it is important to prepare the home ahead of time to ensure an easier recovery. These are some of the tips that can be helpful for preparation

  • It is recommended that a family member or friend be with you for the first few days until you are more independent.
  • Make sure you have rides planned from the hospital and to your first follow-up visit.
  • Most surgeons would not want your wound to be soaked or cleaned prior to follow-up. You will not be able to shower for the first week until the incision heals. Your friend or family member can help you with sponge baths and other hygienic care.
  • As your arm will be in a sling for the first 4-6 weeks following surgery, you should place everything in your house that you use on a regular basis at elbow level. This way you will not have to raise your arm.
  • You will not be able to drive while recovering from shoulder surgery. Make sure all your important appointments or meetings are scheduled before or after the recovery period. If you have to travel to clinic visits or physical therapy appointments, make sure that you have rides or public transportation that allows you to get to your destination safely.

Surgery Day

  • You should not eat or drink after midnight the day before surgery; no breakfast or coffee on the day of surgery
  • Bring a list of your medications with you
  • Bring a loose fitting shirt or jacket that you can put over your shoulder; remember that you will be in a sling after surgery and you will have difficulty putting on a T-shirt or sweater
  • The anesthesiologist will discuss with you the type of anesthesia that you will be having; most patients will have general anesthesia and also regional anesthesia, known as a nerve block; the regional anesthesia can decrease pain during surgery so that less anesthetic agent is needed for general anesthesia and the regional anesthesia can help control pain post-operatively.


 

   

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