The subacromial bursa is a structure that lies between the upper surface of the rotator cuff and the under surface of the acromion. The bursa in fact, is a potential space that lies between two surfaces that move. It is normally formed by two smooth surfaces with a thin film of fluid between them, and it allows for movement to occur by providing gliding surfaces that can move over each other.
Bursas can become inflamed and this is called bursitis. There are many bursas around all of the joints and some of the bursas are particularly problematic. One of these includes the bursa that lies underneath the acromion, called the subacromial bursa. This is the bursa that causes many of the problems in the shoulder.
Inflammation of the bursa can cause aching pain down the lateral aspect of the arm and usually patients with bursitis will have symptoms of impingement.
There are quite a few problems that can lead to bursitis. Patients can have minor injuries which precipitate the inflammation of the bursa. It can be associated with injuries to the rotator cuff, including tears and tendinitis and can be associated with calcium build-up in the rotator cuff. Inflammation related to this calcium build-up is called calcific tendinitis.
Bursitis is usually well treated with steroid injections into the bursa. These steroid injections are true anti-inflammatories and can dramatically improve the inflammation within the bursa.
If you suffer from bursitis, good physiotherapy and cortisone injections have at least a 50% chance of resolving the bursitis for you.
If the steroid injections are unsuccessful and physiotherapy is unable to help, then surgery may need to be considered. Surgery will take the form of removing the bursa (bursectomy) and usually an acromioplasty. An acromioplasty involves arthroscopic (key hole) surgery to remove the under surface of the acromion to create more space to accommodate the rotator cuff. This surgery then allows the shoulder to lift up without the rotator cuff catching on the under surface of the acromion.
Recovery following an arthroscopic acromioplasty and bursectomy is usually fairly rapid and normally occurs within the first 6 weeks following surgery. There is no requirement for patients to wear a sling post-operatively and physiotherapy exercise normally begins within the first few days following the procedure.