The Shoulder

Chronic degenerative bursitis: The complaints recur after initial improvement

Treat with increasing interval
It is recommended to administer the injections with increasing intervals: 10 days - 2 weeks - 3 weeks - 6 weeks. (cfr I.A. injections).

Causal treatment

With repeated relapses, one should consider a causal treatment

Check whether structural (anatomical) alterations cause the relapsing impingement of the subacromial structures.
Structural causes may be:
- Degenerative osteophytes at the level of the acromioclavicular joint
- Abnormal form or degenerative deformity of the acromion
- Deformities at the level of the coracoid or abnormal thickening of the coraco-acromial ligament
- Deformities at the level of the tuberculum majus of the humerus
If an anatomical deviation causes the degenerative bursitis to relapse, then, a definite solution can be offered through a surgical decompression with removal of the front and lower part of the acromion and of the van het coraco-acromial ligament.
Check to see whether any functional cause for the relapsing impingement can be found:
- Presence of a "minor" shoulder instability
- Loss of the normal depression mechanism/(?) of the head of the humerus during elevation; This can be caused by an imbalance between the ab- and adductors during the elevation.
If a functional cause for the relapsing bursitis is found, then, a treatment with functional, proproceptive and muscle strenghtening exercices may be started.