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Shoulder bursitis is an extremely common conditions that we see in the clinic. Traditionally, it has been treated with cortisone injection into the bursa, and closely followed by period of rest. This tends to give short term relief for some people, though may also provide zero change to some individuals. What's really interesting is that up to 78% of people with no shoulder pain have been shown to have shoulder bursitis on an ultrasound. Simply diagnosing from a scan is not sufficient. A skilled physiotherapist needs to thoroughly assess your shoulder, listen to your detailed past history, and also take into consideration your imaging results in order to make a firm diagnosis. Imaging alone is simply a piece of the puzzle, not the diagnostic answer.
What is commonly missed in shoulder pain patients that fail to achieve their outcomes is a targeted and specific strengthening regime to restore normal function to the rotator cuff muscles. There are multiple research articles suggesting that a targeted strengthening regime is the the most successful treatment for a long term fix to shoulder bursitis. This is more important in the chronic shoulder bursitis situations, as the longer someone is in pain generally the more dysfunction the rotator cuff muscle group is in. Though getting this under control in the acute injury phase stops people drifting into chronic cases.
The rotator cuff is simply a group of four muscles that begin on your shoulder blade and continue their journey to your ball of your socket in your shoulder. There's muscles a deep in our body underneath the more famous muscles such as the biceps, tricep and deltoids. The rotator cuff muscles main role is simply to keep the ball (humeral head), within the socket (glenoid).
The issue with pain in the shoulder area is that pain driven muscle inhibition occurs. Put simply, pain in the local shoulder area is interpreted by the brain as a threat, and the brain subsequently and automatically reduces the output of the rotator cuff muscles have. In the short term the brain does this to reduce the threat or impact of any particular injury, though this does not work in the long term as a rotator cuff muscles failed to perform as they should, and the ball is not held dead centre in the socket.This then allows the ball to move a couple of millimetres and allows the ball to then impinge internally on the rotator cuff tendons and also the bursa. This irritates the bursa and the rotator cuff tendons, which may produce what many people see on ultrasound scans as bursitis. We don't tend to think of shoulder bursitis as Diagnosis, it is moreso a symptom of shoulder impingement syndrome.
So the issue with a simple cortisone injection to settle bursitis does not actually address the root cause of having muscle imbalances and reduced endurance for excellent shoulder micro-stability. This short term fix of a cortisone injection is simply that; a potential short term solution. Long term it doesn't work in most people. Hence, this is why a targeted strengthening regime is the best solution for a stubborn shoulder pain.
Don't get us wrong, for the right person and conditions a cortisone injection can work absolute wonders. We suggest these for people that are unable to exercise due to too much pain. But, that's only to reduce the pain so that they can exercise to achieve the solution that they are looking for.