WHAT IS IT?
The space between the acromion and the rotator cuff tendons is known as the subacromial space and is filled by the subacromial bursa. This bursa is a fluid filled sac that allows for smooth gliding of the rotator cuff under the acromion with overhead movements of the shoulder.
Should any abnormality occur affecting the rotator cuff then his can lead to dysfunction. Therefore as the arm is elevated the humeral head would ride upwards closer to the acromion causing impingement. The more the rotator cuff and acromion rub against one another caused by overuse the more the bursa can become aggravated and inflamed which is referred to as Bursitis.
· Gradual onset of shoulder symptoms over weeks or months
· Pain on the outside of the shoulder
· Pain may spread down the arm towards the elbow or wrist
· Pain made worse when lying on the affected shoulder
· Pain made worse when using the arm above your head
· Painful arc of movement – shoulder pain felt between 60 - 120° of the arm moving outwards and up overhead
· There is minimal pain when arm is resting at side and above 120°
· Shoulder pain with activities such as washing hair, reaching up to a high shelf in the cupboard
· Repetitive friction between the greater rotator cuff tendons and the acromion
· Calcium deposition
· Inflammation of supraspinatus tendon
· Shoulder instability
· Degeneration of muscle tendons
· Biomechanical dysfunctions ( such as shortened pec minor protracting scapula)
· Injuries from a fall or hard blow to the shoulder
· Overuse from repetitive activities such as Olympic lifting, overhead pressing
EARLY STAGE MANAGEMENT AIMS
· Increase Range of Movement
· Maintain CV fitness
· Increase strength (isometrics)
· Address causes of issues such as biomechanics, training loads and training environment
IMMEDIATE TREATMENT ADVICE
· Stop any activity that causes the bursa to flare up
· Manual Therapy, ice and anti-inflammatories may help to relieve pain in the short term
· Continue with exercise that does not aggravate the bursa further (such as walking, cycling or lower body weight training
· Address causes of issues such as Biomechanics, Training loads and Training environment
These isometric exercises will help to reduce pain whilst strengthening the muscles in the shoulder. They will also help to reduce any tension within muscles that are tight around that area.