If you click on the link above you can download my patient information booklet. It has detailed information with colour pictures. The following is a summary of the important information.
If you put your hand on the top of your shoulder, the bone you feel below your hand is known as the acromion. Underneath that bone, and in close contact with it is the rotator cuff – part of the muscle that helps lift up your arm. Normally the space between the acromion and the rotator cuff is very tight but a small sac of fluid known as a bursa allows the tendon to glide freely underneath the bone.
As you age the rotator cuff tendon tends to wear out and with this, the bursa can become thick and inflamed. It builds up a large amount of scar-like tissue between the rotator cuff and the acromion. This is known as bursitis. As it is underneath the acromion it is known as “sub” (under) acromial bursitis. Another term for this condition is impingement syndrome named due to the impingement of the rotator cuff on the acromion.
The symptoms of subacromial bursitis are pain, particularly when you use your hand in an overhead position or for activities such as tucking in your shirt or driving.It is also quite common to have pain that may wake you at night.
As mentioned above, the cause is usually the normal ageing process. However an injury can stir up this further. Work may also stir this up but it is important to note that usually an element of degeneration is present before any work injury.
Many people have intermittent bouts of subacromial bursitis that settle spontaneously and no real treatment is needed. Anti-inflammatory medications can be tried and your GP can discuss this further with you.An injection of steroid (cortisone) may help settle the bursitis but we prefer only to do this a small number of occasions as the steroid can damage the underlying tendon. Physiotherapy can also be helpful but you should stop this if it makes your shoulder to painful.
If the subacromial bursitis is severe, surgery is often required. A subacromial decompression is performed. In this operation the undersurface of the acromion bone is shaved slightly to allow more room for the tendon. It then slides more freely and the symptoms are improved. At the same time a bursectomy is performed to remove all the inflamed and scar-like tissue. A new bursa grows back but after removal of the bone it grows back in a normal rather than inflamed condition.
At the time of surgery the rotator cuff is inspected to make sure that it is not torn. If it is torn, repair is usually required and this is discussed in a separate section.
The subacromial decompression and bursectomy can be performed with keyhole surgery and if no rotator cuff repair is required there are no real restrictions on what you can do after surgery. You are allowed to do activities such as driving and normal household activities as soon as you like. We will give you a sling but you can use this just for your comfort and discard it whey you like.
Although the operation is relatively straight forward, the recovery period is very prolonged. You will still have significant discomfort in the shoulder for some months after and it is as long as one year before the full recovery is made.
The natural degeneration of the rotator cuff means that often you will have some minor symptoms in the shoulder after surgery - you will still need to look after your shoulder!
Complications of surgery are relatively rare and they are dealt with in a separate section.