Bursitis of the shoulder joint: how to get rid of the disease

Types of shoulder bursitis

Quite a few types of bursitis are diagnosed, depending on their location, but the main ones are:

• subacromial: occurs when the inflammatory process occurs under the acromial process of the clavicle;
• subcoracoid: appears as a result of dislocation of the joint and affects its outer area;
• subdeltoid - inflammation of the bursa located under the deltoid muscle and thickening of the synovial membrane.

Also, bursitis of the shoulder joint can be: calcareous (calcium salts are deposited and turn into lime), calculous (calcium is already located very deep), subacromial (manifested by pain in the joint, especially when raising the arms to a level above the head), in the form of tendobursitis (inflammatory process combined with thinning of the tendon structure). There are also several forms of this disease: acute, subacute, chronic and infectious.

Coracobrachialis muscle

The coracobrachialis muscle is a long, thin muscle located deep on the anterior surface of the middle third of the shoulder between the biceps brachii and triceps brachii. This muscle, like the pectoralis minor muscle and the short head of the biceps brachii muscle, originates from the coracoid process of the scapula. Its parallel muscle fibers are attached to the medial surface of the humerus between the attachment points of the triceps and brachialis muscles. The deltoid muscle, like its reflection, is located on the lateral surface of the humerus and is attached by a tendon to the deltoid tuberosity.

The coracobrachialis muscle works with the anterior deltoid, upper pectoralis major, and biceps brachii muscles to horizontally flex the shoulder. Shoulder flexion often occurs during a person's daily activities - when lifting objects from the floor, pushing, or when trying to reach something distant. The antagonist muscles for this movement are the posterior deltoid, teres major, latissimus dorsi, and lower portion of the pectoralis major. The coracobrachialis, latissimus dorsi, teres major, pectoralis major, and long head of the triceps brachii muscles work together to adduct the shoulder.

Pulling movements, weight-bearing activities that involve the arms, mountaineering, ring exercises, parallel bars, and pull-ups require powerful shoulder adduction. Also, the coracobrachialis muscle is actively involved in abducting the arms to hit the ball when playing golf, as well as when serving in fast-pitch softball.

Repetitive or prolonged movements that require moving the upper extremities upward or forward (or holding them in such positions) can lead to hypertonicity of the coracobrachialis and related muscles. This problem often occurs among people who work at a computer for a long time, drive a car and write voluminous texts by hand.

Also, the habit of sleeping with your arm under your head and repetitive movements, such as when you paint or clean something, can lead to excessive tension in this muscle and reduced mobility of tissues in this area. Overexertion and decreased mobility of this muscle may result in an inability to place the arm palm up on the table and close to the body when the client is lying supine, as well as decreased ability to flex the elbow when the muscle compresses the nerve supplying the biceps and brachialis muscles.

When this muscle is overstrained, pain is localized in the front and back of the shoulder. Pain occurs when the coracobrachialis muscle is stretched.

Palpation of the coracobrachialis muscle

Client position: lying on the back, arms relaxed and lying along the body 1. Determine the location of the anterior border of the axilla 2. Palpate posteriorly and laterally along the medial surface of the humerus.

3. Determine the location of the muscle belly deep medial to the biceps brachii muscle, following to the place of its attachment to the medial surface of the humerus between the places of attachment of the triceps and brachialis muscles. 4.Ask the client to perform shoulder adduction by palpating the coracobrachialis muscle.

Exercises for a client at home

Shoulder stretch

1.Stand with your back to a door frame or any other firmly fixed object located at shoulder height

2. With the palm of your right hand, grasp the doorframe or firmly fixed object. The thumb points up. 3. Keep your arm and back straight. Step forward to stretch your shoulder. 4. Inhale deeply several times to stretch the anterior deltoid muscle fibers.

5. Change hands and repeat the same thing.

Christy Cal

Why might this disease occur?

This disease can be caused by:

• professional activity: people who do heavy physical work often suffer from bursitis: painters, loaders, lumberjacks, and builders;
• sports training: with repeated movements combined with increased regular and monotonous load, the likelihood of developing an inflammatory process in the bursa is much higher, so athletes (tennis players, badminton players) are susceptible to the disease;
• tissue damage: bursitis can occur as a result of injury, cut or even an injection;
• injuries: a blow to the shoulder or a fall often causes hemorrhage into the periarticular bursa followed by inflammation;
• disease of the musculoskeletal system: sometimes gout or chronic arthritis can become the basis for the development of the disease;
• infectious process in the body: a bacterial or viral infection that enters the bursa through the blood vessels can cause bursitis;
• autoimmune disease: in this case, the aseptic process in the periarticular bursa is a reflection of a similar condition of the joints;
• genetic factor: in some cases the disease is inherited.

With age, the likelihood of developing shoulder bursitis increases, because this joint has the greatest range of motion of all others.

Poor posture is another cause of inflammation. When the body bends strongly forward, the space under the acromion narrows. If this area is narrowed long enough, the pressure on the subacromial bursa, as well as the tendons near it, increases, which leads to the development of inflammation.

Participation in sports[edit | edit code]

The coracobrachialis muscle is involved in shoulder flexion and performs dynamic work during breaststroke and backstroke swimming, bowling, boxing, and static work when stabilizing the upper limb in front during boxing or in an elevated position in gymnastics. As a shoulder adductor, it performs dynamic work in breaststroke swimming and hockey, and both dynamic and static work in ring gymnastics. Participates in exercises of all sports related to movements in the forward arm (hockey, discus throwing, shot put, tennis). In addition, it prevents caudal displacement of the humeral head when lifting heavy objects.

How does shoulder bursitis manifest?

Bursitis is sometimes confused with arthritis, arthrosis and other pathologies of the musculoskeletal system, because at the beginning of the disease the patient only complains of discomfort when raising his arm up. Then the pain increases, depending on the number and nature of movements. If a person does not pay attention to this and does not go to the doctor, but continues to lead his usual lifestyle, then it becomes more and more intense. Therefore, if the joint begins to hurt suddenly, then it is most likely another disease.

Painful sensations are often aching in nature. Also, sometimes a person may feel a slight tingling sensation in the shoulder joint.

With bursitis of the shoulder joint, redness of the skin in the area of ​​inflammation may appear. Sometimes with this disease a person develops chills and body temperature rises. In this case, purulent or septic bursitis can be suspected. In this case, symptoms of intoxication also occur: weakness, dizziness, nausea, vomiting, diarrhea.

Doctors strongly recommend not to put stress on the shoulder if such signs are present. Otherwise, the pain will become increasingly stronger and interfere with sleep.

How to help a sprained shoulder?

With any sprain, assistance to the affected ligaments should be provided at three levels.

1. Urgent action. Immediately after a painful “shot”, the shoulder joint must be immobilized (if necessary, an improvised sling must be built so that the arm is adjacent to the body). Then apply ice to the stretch area (for 20 minutes). Cold procedures with the shoulder joint should be continued for 2 days (3-4 times).
2. Therapy. Anesthetics are prescribed for pain relief, and NSAIDs are prescribed to prevent joint inflammation. A sling or support brace is applied to prevent progression of the shoulder “hinge” injury.
3. Support. If ligaments are damaged, vitamin therapy (A + B + C) and a balanced diet with the addition of hyaluronic acid, chondroitin, and glucosamine are recommended.

Thermal manipulation begins on the 3rd day after the sprain. For children, the use of warming medications is not necessary - the question of prescribing such therapy in case of damage to a child’s joint should be decided only by a doctor.

Physiotherapy and shoulder ligament exercises are used only after the pain has completely disappeared. This is usually 7-10 days after the sprain. Complete restoration of the ligaments, provided there are no tears, is possible in 3–5 weeks.

Diagnostics

Detection of bursitis begins with examination of the patient, study of complaints and the results of the collected anamnesis. Only a comprehensive diagnosis allows the doctor to identify the inflammatory process and its possible causes. To make an accurate diagnosis and identify the degree of articular damage, patients are prescribed the following types of studies:

• X-ray: prescribed to exclude arthrosis, malignant neoplasms and other pathologies. In the picture you can see the condition of the bones of the joint;
• Ultrasound: to clarify the nature and localization of the process, the presence of concomitant diseases of the joint, ultrasound diagnostics is used. In this case, you can examine the soft tissues, and also see the presence of edema;
• taking a puncture of synovial fluid to find out the cause of inflammation;
• CT or MRI: in some particularly complex clinical cases, the diagnosis of bursitis involves computer or magnetic resonance imaging.

Blood supply and innervation

Blood with nutrients and oxygen flows to the coracobrachial muscle through the anterior and posterior arteries surrounding the humerus . They supply not only the muscular-ligamentous apparatus, but also the entire shoulder joint.

Innervation occurs due to the musculocutaneous nerve extending from the lateral bundle of the brachial plexus. Passes between the brachialis and biceps brachii muscles, intertwined with the fibers of the lateral cutaneous nerve of the forearm. The cervical nerves C6-C7 depart from it, which make the CPM sensitive.

Diagnostic measures

During the diagnosis, the doctor checks muscle strength.
If the coracobrachial muscle is damaged, the specialist will palpate the problem area and identify painful lumps indicating the presence of a pathological process. Further diagnosis involves assessing the range of motion . They are limited and extremely painful during shoulder flexion and extension.

Muscle strength is also . The patient, in a sitting position, moves his shoulder back, partially bending his arm. The doctor presses down on the elbow, pressing it from the back. With weakened muscle strength, resistance does not occur, the hand becomes pliable.

Another standard examination is rubbing . The patient, in a sitting position, places his hand behind his back and begins to rub the back area with the back of his hand. If the muscle is affected, movements are not performed in full. The person experiences severe pain and discomfort.

If an inflammatory process is suspected, the specialist will refer the patient for arthoroscopy, blood and urine tests, ultrasound, MRI, and radiography of the shoulder. Based on the examination results, he prescribes therapy.