Bursitis is a common diagnosis for non-specific shoulder pain, however there may actually be a rotator cuff problem, joint problem, fascial restriction or even some other seemingly unrelated issue.
The following is question I received a while ago and it is a very common scenario.
” I went to the doctor about 10 days ago after suffering from severe shoulder pain for a week. She gave me Diclofenac, a strong non-steroidal anti-inflammatory medicine. She said it works quite well on bursitis, but if it’s not better in a week or two to come back. Well, it’s not better and it’s been nine days. Of course I will go back if it keeps hurting. But, I’m wondering if anyone else has experienced this and how long it took to get better. I can’t stand it anymore, I can’t even pick up a cup of coffee without screaming!”
I asked “Did your physician touch your shoulder and test it and reproduce your symptoms? Did you have an x-ray or MRI for the diagnosis?”
This person responded “She did touch it, mostly did strength and ROM tests. She told me if I end up having to come back, they’d do more exploratory tests. So, no… she didn’t give me an x-ray or MRI. She’s just my regular primary care physician…
After rest it will get a little bit better, but the minute I use it in any way, shape or form it becomes a-n-g-r-y. Anyway, thanks for your reply… Have a good weekend.”
My follow up reply: “It’s good that your physician did not order an X-Ray or MRI yet. It’s not always necessary to determine the problem or to help you feel better and return to pain free activities.
If the Diclofenac did not reduce your pain or symptoms, you definitely do not have inflammation and bursitis means inflammation of the bursa, which is a fluid filled sac that cushions and protects part of your joint. Often “bursitis” is the term used for pain in a joint when the problem is really a muscle pain and spasm. If you did have an acute bursitis this medication should have made an impact or different in how you feel.
The problem is probably soft tissue related, either muscle, fascia or both. Pain in the shoulder can be a result of a primary injury or from a guarding response due to an internal derangement or damage to the soft tissue.
I would strongly suggest an evaluation with a physical therapist, preferably a therapist that specializes in manual physical therapy and soft tissue manipulation/massage. You probably do not need a referral, but should contact the PT office of your choice and ask them what they need and most likely, you can be seen very soon.”
Shoulder Bursitis, Rotator Cuff Tendonitis are typically symptoms of a deeper problem and have to do with how your shoulder moves and the tissue restrictions that cause it to move improperly thus causing trauma to the tissues in your shoulder joint. This improper movement can cause an impingement of the rotator cuff tendons, and even irritation of the bursa, but most likely your shoulder hurts because of guarding of the muscles to protect your shoulder from further self injury or repetitive strain. This may be cause by a direct injury such as a fall, or repetitive injury such as swinging a tennis racket or gradual tightening over the course of time.
Many times the pain you are experiencing that causes you to see your primary care physician is just the symptom of a deeper problem. Your first course of action, once you discover that there is no immediate danger from your condition, should be to seek treatment from a physical therapist. Physical therapists are experts in soft tissue dysfunction, movement problems, and joint and soft tissue mobilization. A physical therapist can help you live a pain free life and return to work and your favorite activities with out expensive medications, diagnostic tests or surgery.
Pro+Kinetix Physical Therapy & Performance specializes in helping active individuals in Oakland, Alameda, Berkeley, Walnut Creek, and San Francisco get back to exercising and working out pain free without having to take time off or relying on injections/pain medication. Pro+Kinetix offers rehabilitation and performance services to all populations, with specialties in Sports Rehabilitation, Active Release Techniques, and Manual Therapy Techniques plus Personal and Small Group Training, Sport Clinics and Wellness Services.