Subacromial impingement syndrome

Tendonitis/bursitis of the shoulder

The shoulder joint is unusual in that it has controlling tendons that act like ligaments and muscles within the joint itself. These ‘rotator cuff’ tendons can become irritated if there is not enough space for their motion, rubbing on the underside of the acromion bone. The biceps tendon at the front of the joint can suffer in a similar way, so bicipital tendonitis is often found when examining the condition. The bursa is a small fluid sac that acts as a friction absorber inside the joint and once this becomes inflamed, the condition becomes virtually unmanageable because the shoulder hurts most of the time, especially at night. In these cases, patients often are referred to the GP for a diagnostic ultrasound and guided cortisone injection to reduce the inflammation so that rehabilitation can progress.

This is one of the most challenging conditions we face as osteopaths because of the complexity of the shoulder joint. Once its control system breaks down and inflammation sets in the condition can drag on for months. In some cases it is a pre-curser to an even more debilitating condition called adhesive capsulitis – or ‘frozen shoulder’.