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The symptoms of a shoulder bursitis

Impingement, or subacromial conflict, is a painful pinching of the rotator cuff, and the bursa covering it, that occurs during large movements of the shoulder when there is compression by overlying bony structures (the acromion and/or distal clavicle).
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The symptoms of a shoulder bursitis

Impingement, or subacromial conflict, is a painful pinching of the rotator cuff, and the bursa covering it, that occurs during large movements of the shoulder when there is compression by overlying bony structures (the acromion and/or distal clavicle).
Contact us to make an appointment

The symptoms of a shoulder bursitis

Impingement, or subacromial conflict, is a painful pinching of the rotator cuff, and the bursa covering it, that occurs during large movements of the shoulder when there is compression by overlying bony structures (the acromion and/or distal clavicle).

This phenomenon occurs mainly in people who have bone spurs on the anterior part of the acromion (type II or III acromion) or on the distal clavicle (for example, in osteoarthritis). These bone spurs are either structural (genetic) or develop gradually with age, often after age 40. Impingement is fairly rare in people under 30, when it is usually due to a glenohumeral joint instability problem known as ligament hyperlaxity.

A bit of anatomy

A tendon is a whitish structure that attaches muscle to bone. When the muscle contracts, it causes the bone to move or, alternatively, works with another muscle called an “antagonist” to stabilize the bone.

The rotator cuff is formed by the tendons of four muscles that attach to the scapula. The four muscles are the subscapularis (at the front of the shoulder, rotates the arm internally), the supraspinatus (on the top part of the scapula, moves the arm up and away from the body), the infraspinatus and the teres minor (on the posterior part of the scapula, rotates the arm externally). The combined action of these four muscles keeps the head of the humerus centred in the glenoid (i.e., the arm in front of the scapula) to allow the different power muscles, such as the deltoid, pectoralis major and latissimus dorsi, to move the arm with strength and power

The rotator cuff forms a covering around the humeral head. It lies under a bony mass made up of the distal clavicle and the acromion (an extension of the scapula). A thin layer of tissue called the bursa acts as a “cushion” that permits smooth gliding between the cuff and these bony structures.

What are the most common causes?

Since a healthy tendon is an extremely strong structure, tears occur in tendons that probably already show some degeneration.

  • Compression can occur when the arm is fully or repeatedly elevated to the front or the side (abduction) in combination with certain rotation movements.
  • These situations can occur at work or when practising certain sports.
  • Impingement can also occur at night, especially when lying on the stomach.

What are the symptoms?

Pain at night may wake a person up, and the lack of restorative sleep can cause chronic ill-humour.

When impingement occurs over a long period of time, it can cause inflammation of the rotator cuff or the bursa covering it (bursitis, peritendinitis). It can also cause gradual abrasion of the rotator cuff that will degenerate to a tear of partial or full thickness. At that point, it has become a destructive friction caused by an abnormal pressure point, a little like having a pebble in your shoe.

How is it diagnosed?

The bony morphology can be seen on certain X-ray profile views. But since impingement is a mechanical phenomenon related to movement, it can only be diagnosed following an appropriate physical examination that reproduces the movement causing the impingement (which will also rule out the possibility of adhesive capsulitis, often missed) or by dynamic ultrasound imaging. A classification (grade 1 to 3) of impingement, seen through active ultrasound, was developed a few years ago by myself and a team of radiologists in Montreal and is now commonly used worldwide.

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Five months after my operation, despite the severity of my wound, I am again able to ride a bike without difficulty or pain. I had an impeccable and attentive follow-up from Dr. Beauchamp. Thank you!

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A few client testimonials

Don’t just take our word for it: read on to see what our patients have to say!

« Dr. Beauchamp reconstructed almost my entire shoulder after I fell from a 10-foot ladder. Just six months later, I was able to do work on my properties without any pain whatsoever. Thank you, Dr. Marc, for everything you’ve done! »

« I had a surgical procedure done on my left shoulder. My recovery was remarkable and I am a very happy man. I would recommend Dr. Marc Beauchamp without hesitation; his excellence has no price! »

« Dr. Beauchamp operated on my son to repair a torn shoulder ligament. After 18 months and all of the physical contact to which a 17-year-old hockey player can subject a shoulder, we can confirm that the operation was a complete success! »