Shoulder Pain: Bursitis and Treatment Options

Shoulder pain - bursitis

Pain in both shoulders, pain when sleeping on either side, numbness and pain in the feet, pain when reaching for a bra, limited range of motion when raising the arms and externally rotating them at a 90-degree angle.
I have been receiving shockwave therapy and glucose injections for a long time without improvement.
Should I consider manual therapy? I changed hospitals and after an X-ray, the doctor mentioned that there is a narrowing of the cervical and lumbar disc spaces.
They suggested spinal and neck traction, stating that the hand pain would improve without the need for manual therapy.
I have been doing wall stretches at home but have not seen any improvement.
The doctor diagnosed me with muscle tendonitis; is tendonitis the same as bursitis? Can an X-ray show adhesions? I injured my knee by slipping and falling to the ground.
Is it possible to receive both shockwave therapy and glucose injections at the same time? Thank you, doctor.

Jia You, 50~59 year old female. Ask Date: 2024/04/24

Dr. Wang Zhaomin reply Rehabilitation

When joint mobility does not improve with initial treatment and self-stretching, it may be beneficial to consider rehabilitation exercises and manual therapy for cervical and lumbar spinal stenosis, along with traction therapy, which should gradually alleviate symptoms.
Tendons and bursae are both soft tissues associated with skeletal muscles but have different structures and can both become inflamed, leading to pain and other symptoms.
X-ray examinations primarily assess skeletal issues, while joint adhesions should be evaluated with appropriate physical examinations for further diagnosis.
Shockwave therapy and glucose injections should not be performed simultaneously; please consult with a physician to discuss relevant treatment options.

Reply Date: 2024/04/24

More Info

Shoulder pain can be a complex issue, often stemming from various underlying conditions, including bursitis, tendonitis, or even issues related to the cervical spine. Based on your description, it seems you are experiencing bilateral shoulder pain, which is exacerbated by certain movements and positions, such as sleeping on your side or reaching for items. Additionally, you mentioned experiencing numbness in your legs and pain in your feet, which could indicate a broader issue involving nerve compression or irritation.

Understanding Bursitis and Related Conditions
Bursitis is an inflammation of the bursa, a small fluid-filled sac that acts as a cushion between bones and soft tissues. In the shoulder, the subacromial bursa is commonly affected, leading to pain and restricted movement. Symptoms of bursitis often include:
- Pain when lifting the arm or reaching overhead.

- Tenderness and swelling in the shoulder area.

- Pain that worsens at night or with certain activities.

Your symptoms of limited range of motion, particularly with external rotation and overhead activities, align with common presentations of shoulder bursitis or tendonitis. It’s important to note that while tendonitis refers to inflammation of the tendons, it can coexist with bursitis, as both conditions often result from similar repetitive motions or overuse.

Diagnostic Imaging and Treatment Options
You mentioned having X-rays taken, which can help identify bone-related issues but may not show soft tissue conditions like bursitis or tendonitis. MRI is often more effective for visualizing soft tissue structures and can help confirm a diagnosis of bursitis or tendonitis.

Regarding treatment, you have already undergone shockwave therapy and glucosamine injections, which are often used to alleviate pain and promote healing. However, if you are not experiencing improvement, it may be beneficial to consider additional treatment options:
1. Physical Therapy: Engaging in a structured physical therapy program can help improve shoulder mobility and strength. A physical therapist can provide specific exercises to address your limitations and pain.

2. Manual Therapy: Techniques such as joint mobilization or soft tissue manipulation may help relieve pain and improve function. If your current physician does not recommend manual therapy, seeking a second opinion from a specialist in musculoskeletal disorders may be worthwhile.

3. Corticosteroid Injections: If inflammation is significant, corticosteroid injections can provide temporary relief and reduce inflammation in the affected area.

4. Activity Modification: Avoiding activities that exacerbate your symptoms is crucial. This includes modifying how you sleep or perform daily tasks to reduce strain on your shoulders.

5. Alternative Therapies: Acupuncture and dry needling are other options that some patients find beneficial for pain relief.

Addressing Nerve Symptoms
The numbness in your legs and feet could suggest a cervical spine issue, particularly if there is narrowing of the intervertebral spaces as you mentioned. This could lead to nerve root compression, which may manifest as pain or numbness in the extremities. It’s essential to address these symptoms with your healthcare provider, as they may require a different treatment approach, such as cervical traction or further imaging studies like an MRI of the cervical spine.

Conclusion
In summary, your shoulder pain may be due to bursitis or tendonitis, and while X-rays are helpful, further imaging like an MRI could provide more clarity. If current treatments are not effective, consider exploring physical therapy, manual therapy, or corticosteroid injections. Additionally, addressing any cervical spine issues is crucial, especially if you are experiencing nerve-related symptoms. Always consult with your healthcare provider before making changes to your treatment plan, and don’t hesitate to seek a second opinion if you feel your concerns are not being adequately addressed.

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