Injuries

I've had Bursitis of the shoulder now for about 4 months, maybe more. That has been brought on by a muscle in the shoulder being torn in a few places along its length. I can't raise my hand above my shoulder.



Basically means I can't sail until it is healed. The second cortisone injection did nothing. Ibuprofen is becoming a food group for me.

Now, I'm wondering if windsurfing did it to me. I doubt it as that muscle doesn't get sore from a big sail, and it doesn't hurt when I sail as I am now (except for getting sail out of water).

My question is: Has anybody else suffered bursitis of the shoulder/is it from windsurfing?

Unlikely that windsurfing in the cause of such an injury. This is one of the most common shoulder complaints that occur without any specific mechanism. Two basic causes are, exactly as you highlighted

1 You fall and injure the soft tissues directly, whether it be a rotator cuff muscle tear or impact to the shoulder irritating the sub-acromial bursa resulting in inflammation, pain and limitation of movement (commonly known as impingement).
2 Through years of posture, repetitious activities, you develop a muscular imbalance and over time suffer from an irritation to the bursa +/- degenerative tear in the rotator cuff.

In both circumstances depending on where the muscles are torn, they have very poor healing potential, due to really poor blood flow. However, if your condition was not traumatic, the muscle tears are unlikely to be the cause of your problem, but are actually another symptom. The inflammation in the bursa (bursitis) causes the impingement (google it - it will explain the mechanism of pain) and hence pain.

Cortisone is a mass dose anti-inflammatory, it will not fix the problem, if your cause was due to muscle imbalance, posture and the like. Can you can't put your hand behind your back beyond your waistband? This would indicate the shoulder capsule is really tight, and until you lengthen this you will have gradually worsening trouble. You will also need to strengthen your rotator cuff, work on your upper back, address your working posture and a few other things.

If you haven't worked it out - I'm a physio, bored by the rain and lack of time on the water

Regarding an MRI. Yes it is the gold standard, but unless it is matched with clinical symptoms, it won't help you fix things any quicker. An ultrasound is more than adequate for diagnosis around the shoulder, for low level complaints like this. EP your GP will not be able to fix this and it is unlikely a surgical case from what you have described. Cortisone will not fix it!!!!!!! it may give you relief for a time, but in my experience your symptoms will come back, and if you have already had 2 injections, unlikely they will do a 3rd in that joint any time soon. Basically, go and see your physio if you have one. If not find one that will combine hands on treatment with a comprehensive exercise program. You want to avoid the electro physio approach - machines don't really help.

With good care and you doing your exercises, should be good as new in 4-6 weeks (assuming a simple bursitis). PM me if i can help further.

All good advice above from DAM but didn't work for me. Then again, mine was caused by a catapault 6ft up in 40knots........not gradual overuse type injury.



Do the exercises and see a good pysio but if they don't work, go see a surgeon, get an acromioplasty (acromion ground off to make room for the bursa) and you'll be sailing pain free with full range of movement 8 weeks later.

BTW I disagree with DAM, ultrasound showed bugger all with mine, but an MRI showed i needed surgery. If you see a surgeon and they refer you for MRI then it is covered by Medicare, and you participate in an extreme sport and wanna be 100%, so why not go get one?

Thanks peoples.

1. I've been doing yoga, very casually, for many years. By the way yoga is the bomb. I do perhaps once a week, informally, and the next day you feel like you've had a pro massage.

i.e. I have at least an average level of suppleness. I can easy reach my shoulder blades up my back.

2. Went to physio. We noticed a definite plateau after a few weeks so he forwarded me to a specialist, then the cortisone.

3. Ultrasound shows swollen bursa and muscle is frayed along its length.
X-ray showed no impingement from bones growing odd etc.


But the good news is that all seem to agree this is not the type of injury that would be sustained from windsurfing. Except for trauma from being catapulted 6ft up in 40 knots (nice), general freeriding ain't going to do this. I can now assure the family I'm not the only one that thinks so

Hi Ken,

With respect my advice and suggestions for EP were by no means un-informed. He asked for an opinion re the condition bursitis - that is a diagnosis by the way, the fact he described the shoulder its a safe bet he is talking about the sub-acromial bursa.

Regarding MRI's vs USS. USS is more than adequate for intial diagnostic purposes for the majority of conditions. I agree that it's accuracy is not as good as MRI, but then the true gold standard of investigation will be arthoscopy, but i doubt many will line up for a quick surgical look. However, an MRI cannot indicate which structure is causing you pain as you mentioned in your origial post. It will only show a more detailed picture of what is damaged, it will not highlight muscle function, soft tissue tightness and so on. Only the full clinical picture, including history and physical examination and then further on the course of progression are what determines the course of management we take, not the investigation. The shoulder is a particular joint where there are cases of degenerative muscle tears that have little to no pain and minimal functional loss, however, if we were to investigate with USS or MRI the reports would indicate significant injury ie full thickness tear of supraspinatus, which can be only repaired with surgery. The outcome of such surgery may result in no further improvement in the condition, with the associated risk of a poorer outcome. So what should the clinical decision be made on? The investigation or the clinical picture.

I apologise for this going off track, and it sounds like EP is doing everything right. EP it may just take time and persistence with your strengthening program, furthermore, you may have to look at your day to day activities, and try and identify if something there is the cause of your aggravation. Either way good luck, and if surgery becomes the next step, make sure you go in fully informed, and having done all the rehab prescribed.

when i get up in the morning it's like an orchestra of clicks and pops. every joint in my body makes noises

Woah dude, I in no way suggested that you are un-informed.
However, I am equally well-informed, by dint of my medical degree, FRACGP and 20 years of clinical experience.
I just have a difference of opinion about the validity of USS. They are crap for shoulders !!
I am aware that "bursitis" is a diagnosis, but I dispute that there is enough evidence for that diagnosis to go unchallenged at this point, particularly since it tends to respond well to cortisone injections. Of course, if the injection was done "in rooms" without USS guidance, the precision of site may be an issue.
With the extra info provided in his last post, I think it is more than reasonable to suggest that EP have an MRI. He has on-going symptoms in the face of good conservative treatment.
MRI will show things that cannot be seen on any other imaging modality, and whilst arthrsocopy may be the gold standard, as you pointed out, it's invasive and difficult, vs the non-invasive ease of MRI.
Even some of the recalcitrant shoulder orthos on the GC who were resistant to MRI are coming around to appreciating it.
Call me a fan-boi, if you will.
At no point did I suggest that the MRI result be treated, rather than the patient.
I don't think you can argue that he has an asymptomatic degenerative tear. If you want an investigation that will overcall injuries, then look no further than USS. I've seen simple bursitis reported as full thickness tears of 3 tendons. I would not accept the USS report EP has conveyed of multiple site of tendon tears as valid.
I don't mind the discussion, and I don't think it's off-track to raise these issues for EP. It's a complex subject with a lot of grey areas.
Just don't patronise me.

I tore my shoulder in a jetskiing accident in May 2007. I had 11 rounds of cortisone between then and August 2009 - I was desperate not to have the surgery - so many bad stories. I got jack of nursing myself so I went back to windsurfing. It did take some time to work out the optimum boom height (lower than I used to have it) and now I am almost pain free. I was under the care of a specialist during this time who said "no more" to the cortisone. So I may be kidding myself and my recovery could be all in my head. Mind you, I don't care. I've been back windsurfing for over a year now and my shoulder is holding up well. I am very careful how I use the shoulder and any sign of pain I stop what I'm doing. I also found full extension bicep curls with dumbells irritate the injury so I only use a barbell and really watch my angles.

I hope it gets better for you.

If you have huge tears then you will probably do well with surgery.
The injection goes into the sun-acromial space, so next to the bursa.
I never really commented on whether windsurfing can cause or aggravate shoulder injuries, but I think it would be naive to say it would not.
The comment below about boom height is pretty relevant, I think.
A higher boom puts more stress on the shoulder joint. My shoulder gets a bit sore after a big sail. I favour a lower boom these days to help look after it.
I was talk to a SUP shop owner recently about paddle length, and he said that all the old blokes doing SUP are reporting that too long a paddle will stuff a shoulder in no time.

I get the impression that you have seen an ortho, but if you have not, then a visit to an upper limb specialist is in order.
There are some very good ones in Brisbane, one in particular, whose name I can't think of at present, though I've been trying to remember for you.
I still think you need an MRI.
Tears on USS appear as dark spots, but severe bursitis will produce the same appearance because of free fluid, hence my issues with the accuracy.
USS accuracy in chronic degenerative tears is irrelevant and untested, as those patients do not go to surgery and do as well as they are going to with conservative management.

evlPanda said...

Hey, this is better than going to the doctor.

The cortisone injections were done under Ultrasound. Question: Is it supposed to go into the bursa or right next to the bursa? To be honest I looked away at that point, but I'm pretty sure it was right next to.

Also, keeping it related to windsurfing I think/fear it was caused by carrying big gear and/or carrying luggage through airports. I do a lot of it.

Regarding the muscle tears, the doc gasped when he saw them. Bursa is huge.
Seems to have calmed down a bit this week with ibuprofen, of course it could be simply masking it.

But, am I right in thinking that because the injury works on a bit of a feedback loop, the muscle is damaged so bursa swells leaving less space for muscle so muscle is damaged and bursa swells... I should be trying to reduce swelling of bursa as much as possible? Thus anti-inflammatories or ibuprofen. I am taking about 1/3 - 1/2 recommended dose, like a good boy. Just enough to reduce pain.

Hi EvlPanda, Im no doctor but for what its worth I go in for my second Op in 7 days, I had my right done 13 months ago after major off destoryed right sholder, and tore the left sailing in Maui. If you sail regularly it will not improve and sounds serious as with two torn ligiments and muscle tears I could still hold my right arm above my head. I would suggest go to a surgen and have the decompression done. The injections are a waste of time and money, also you can only have a number of them before they weaken the tendons in the shoulder.

If you live on the Gold Coast I can recomend Terry Hamond as a surgeon he is also a windsurfer and understands your plight.

Hi Ken, sorry if read into my last post that i was patronising you, that was not my intent. I think you may not have been getting the gist of what i have been trying to say - which is always difficult with the typed word.

For instance i did not claim that EP had an asymptomatic degenerative tear, but merely used that as an example. BTW I'm sure you are aware the prevalence of such injuries is actually quite high >20% in the over 50's, and increases with age. The question that is much harder to answer is what could cause an asymptomatic tear become symptomatic in the absence of trauma. I have just read an interesting paper from Acta Orthopaedica regarding such - for another day.

Anyway, you got me thinking so i have done a little research, and in light of your medical opinion, you may be interested to know that a 2009 paper in the American Journal of Roentgenology reported that there are no significant differences in either sensitivity or specificity between MRI and ultrasound in the diagnosis of partial- or full-thickness rotator cuff tears (p > 0.05). It highlighted that MR arthrogram is more specific and sensitive than either MRI or ultrasound. Now i believe that MRI is a better quality image, as i have said all along, and believe it will show tear characteristics such as location and extent with more clarity, but i stand by my original position that it is more than adequate as an intial diagnositc tool for assessing shoulders.

But again this is most probably whilst interesting for you and i to discuss, of little benefit to EP. I agree that in the light of EP's more recent post, he may well need further investigations, however, i find it more interesting that low dose ibuprofen is offering him relief, where cortisone did not. For the record, my observations regarding cortisone would have more failures than successes, it may calm the symptoms temporarily, but usually the pain returns, especially in conditions that are more chronic. Keep in mind my figures will be skewed, because the people that i tend to see, have already had cortisone fail. Interesting they usually have never had any rehab prior to the injection, which leads me to believe, it is still widely used in medical practice.

Regardin EP's particular complaint, if you have been diligent with rehab, and followed advice and are not improving then it may be necessary for further investigation. Sometimes, however, it just takes a long time, and persistance, and like i mentioned earlier, try to determine what / if any things you may be doing to continually aggravate the shoulder, and be comfortable that your physio has addressed all potential biomechanical problems; including but not limited to scapular stability, (not just rotator cuff exercises), thoracic mobility, shoulder capsule length, shoulder position (fwd/back) ie tight chest / round shoulders and stuff like that, and finally if there is a neuro-mechanical component (type of nerve irritation).

On a general health note if you smoke stop - decreases oxygen in blood therefore slow healing, vitamin B supplement - good for mitochondrial action may help improve soft tissue healing (eat your spinach), heat promotes blood flow - get a wheat pack. Decrease stress - its not good for you, eat healthy, and exercise.

Good luck.