For individuals experiencing shoulder and upper back pain, could periscapular bursitis be a possible cause?

Periscapular Bursitis

The scapula/shoulder blade is a bone that shifts position with upper body and shoulder movement. The scapula motion is critical to the normal function of the shoulder and the spine. When abnormal or sudden shoulder movements occur, inflammation and pain symptoms can develop. (Augustine H. Conduah et al., 2010)

Normal Scapula Function

The scapula is a triangular bone on the upper back outside the rib cage. Its outer or lateral side contains the shoulder joint socket /glenoid, while the rest of the bone serves as attachment points for the different shoulder and back muscles. The scapula shifts on the rib cage when moving the arm forward and back. This movement is called scapulothoracic motion and is critical to the normal function of the upper extremity and the shoulder joint. When the scapula does not glide in a coordinated motion, the function of the torso and shoulder joints can become stiff and painful. (J. E. Kuhn et al., 1998)

Scapular Bursa

A bursa is a fluid-filled sac that allows smooth, gliding motion between structures, body tissues, bones, and tendons. Bursae are found throughout the body, including those in front of the kneecap, outside the hip, and at the shoulder joint. When a bursa becomes inflamed and irritated, normal movements can become painful. There are bursae around the scapula in the upper back. Two of these bursa sacs are between the bones and the serratus anterior muscle that controls scapular movement on the chest wall. One bursa sac is located on the upper corner of the scapula, close to the spine at the base of the neck, and the other is at the bottom corner of the scapula, close to the mid-back. Either or both bursa sacs can be affected by periscapular bursitis. There are other bursae around the scapula and the surrounding tendons, but the two corner sacs tend to be the primary bursae that develop periscapular bursitis.

Inflammation

When these bursae become inflamed and irritated, swollen, and thickened, the condition known as bursitis results. When bursitis occurs near the scapula, muscle, and shoulder blade movements can lead to discomfort and pain. The most common symptoms of periscapular bursitis include:

• Snapping with movement
• Grinding sensations or crepitus
• Pain
• Tenderness directly over the bursa (Augustine H. Conduah et al., 2010)
• Abnormal scapular sensations and movements

An examination of the scapula may display abnormal movements of the shoulder blade. This can lead to winging, where the shoulder blade is not held correctly to the rib cage and protrudes abnormally. Individuals with winging of the scapula typically have abnormal shoulder joint mechanics because the shoulder’s positioning is altered.

Causes

The causes of periscapular bursitis can be varied. The most common is overuse syndrome, where a specific activity is causing irritation to the bursa. These can include:

• Sports-related activities that result from repetitive use.
• Work-related activities that result from repetitive use.
• Traumatic injuries that cause inflammation or irritation to the bursa.

Some conditions can cause abnormal anatomy or bone protuberances, irritating the bursa. One condition is a benign bone growth known as an osteochondroma. (Antônio Marcelo Gonçalves de Souza and Rosalvo Zósimo Bispo Júnior 2014) These growths can project off the scapula, leading to irritation and inflammation.

Treatment

Treatment of periscapular bursitis begins with conservative therapies. Invasive treatments are rarely needed to correct the problem. Treatment can include:

Rest

• The first step is to rest the irritated bursa and settle the inflammation.
• This can take a few weeks and can be accomplished by modifying physical, sports, or work-related activities.

Ice

• Ice is useful for reducing inflammation and controlling pain.
• Knowing how to ice an injury properly can help manage the pain and swelling.

Physical Therapy

• Physical therapy can alleviate the symptoms of inflammation through various exercises and stretches.
• The therapy can improve scapular mechanics so the injury does not become ongoing and recurrent.
• Abnormal movement of the scapula on the rib cage can not only lead to the development of bursitis, but if these abnormal mechanics are not addressed, the problem may recur.

Anti-Inflammatory Medications

• Non-steroidal anti-inflammatory medications are used to control the inflammation in the short term. (Augustine H. Conduah et al., 2010)
• The medications can help block the inflammatory response.
• Before taking any medication, individuals should confirm with their healthcare provider that it is safe.

Cortisone Injections

• Successful treatment with a cortisone shot is a sign that surgery will be more effective for individuals who may need surgery.
• Cortisone injections can be very helpful in delivering a powerful anti-inflammatory dose directly to the site of inflammation. (Augustine H. Conduah et al., 2010)
• Cortisone injections should be limited in terms of how many injections are offered to an individual, but in limited doses can be very helpful.
• However, cortisone shots should only be performed once the diagnosis is confirmed.

Surgery

• Surgery is seldom necessary but can be effective in individuals who are unable to find relief with conservative treatments.
• Surgery is often used for individuals with abnormal scapular anatomy, like bone growths or tumors.

At Injury Medical Chiropractic and Functional Medicine Clinic, we treat injuries and chronic pain syndromes by improving an individual’s ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. Our chiropractor care plans and clinical services are specialized and focused on injuries and the complete recovery process. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, and/or ailment.

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Scapular Winging in Depth

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References

Conduah, A. H., Baker, C. L., 3rd, & Baker, C. L., Jr (2010). Clinical management of scapulothoracic bursitis and the snapping scapula. Sports health, 2(2), 147–155. doi.org/10.1177/1941738109338359

Kuhn, J. E., Plancher, K. D., & Hawkins, R. J. (1998). Symptomatic scapulothoracic crepitus and bursitis. The Journal of the American Academy of Orthopaedic Surgeons, 6(5), 267–273. doi.org/10.5435/00124635-199809000-00001

de Souza, A. M., & Bispo Júnior, R. Z. (2014). Osteochondroma: ignore or investigate?. Revista brasileira de ortopedia, 49(6), 555–564. doi.org/10.1016/j.rboe.2013.10.002