The Shoulder

Help - Treatment

Chronic degenerative bursitis: There is no improvement with the current treatment

Are you sure about the diagnosis?
- The pattern of a chronic degenerative bursitis with a capsular rupture can be rather complicated.
- Active elevation is usually very limited (rupture of the supraspinatus and accumulation of fluids in the subacromial space).
- There is usually a very pronounced painful arc.
- The resisted movements are usually painful and/or weak as the result of transmitted stress or as the result of capsular ruptures. This can make the differential diagnosis with tendinous ruptures difficult.
- Extensive accumulation of fluids in the subacromial space can cause some limitation of movement through which de differential diagnosis with a l minor capsular pattern is sometimes difficult.
Are you sure of the location?
- The acromio-deltoid bursa is rather extensive and, therefore, the right location is not always evident. A local infiltration can only produce results if the right location is being found. Therefore, it is first of all important to palpitate thoroughly the subdeltoid region and to compare for tenderness and swelling with the other side.
- Always add a local anaesthetic to your solution (technique).
- Repeat the function-examination after the infiltration. If the signs have not disappeared, concentrate on another part of the bursa. (technique)
Treatment with steroids?
- A degenerative bursitis does not react to local anaesthesia alone. Therefore, infiltrate the location with a mixture of a local anaesthetic and triamcinolone (depending on the extension of the lesion with 10 to 40 mg).
- It is important to aspirate the bursa and empty it as much as possible before the infiltration is given.
- Repeat the injection every two weeks until the complaints have completely disappeared (normally after two to three injections).