The Bursa (lubricating sac) can become inflamed causing bursitis. The causes include: throwing sports and overhead activities, such as painting, hanging wallpaper or washing windows. The chance of developing the condition increases with age.

The Rotator Cuff Tendons causing tendinitis. This may occur when an overly aggressive training program is started by someone whose muscles are poorly conditioned. In younger athletes the causes of tendinitis are similar to those of bursitis.

Calcium can be deposited in the tendon causing pain, again the chance of this increases with age this increases with age

There is usually no single acute initial episode and, at first, only minor pain and a slight loss of strength may be noticed. Loss of range of motion, especially the ability to lift the arm overhead, is often ignored for several months.

The symptoms of both conditions include:

• Mild to severe pain.
• Limited movement.
• Inability to hold the arm in certain positions indicates tendinitis is present.
• Recurrent episodes of tendinitis may indicate a rotator cuff tear.

The pain often has two forms: A continuous dull ache, which is often worse at night, is usually located over the lateral aspect of the shoulder joint and may extend someway down the side of the arm even as far as the elbow. Often it does not appear to be coming from the joint at all.

Sharp pain on lifting the arm is felt below the acromion (the bony prominence at the top of the shoulder). The pain usually starts when the arm reaches horizontal and eases off if the arm can be brought all the way to vertical. This is the so called “painful arc”.

The doctor will listen to the description of the symptoms and examine the shoulder. X-rays will be taken to examine the shape of the acromion and to help exclude other pathology within the shoulder.

It is often not possible to differentiate between bursitis and tendinitis, however the treatment is the same.

• Avoidance of aggravating activities.
• Anti-inflammatory medication should be used and may be all that is required.
• Local injection of local anaesthetic and steroid often settles the acute episode.
• After the inflammation subsides, the patient should undertake shoulder strengthening exercises.

If the symptoms persist despite conservative treatment, the shoulder will be re-examined to exclude a rotator cuff tear. It may be necessary to perform an arthroscopic subacromial decompression (acromioplasty) in which the undersurface of the acromion is shaved to prevent it rubbing on the rotator cuff.