How will physical therapy help my bursitis get better?
 

I was recently diagnosed with shoulder bursitis after a fair amount of shoveling snow last month, and I was told to visit a physical therapist. I have gone a couple of times and I do not feel any better. I a bit confused as to how PT works for this diagnosis, and how I will know if surgery is necessary.

Understanding why PT may help "bursitis" resolve requires understanding the nature of the problem. I encourage you to view the videos on the Shoulder Section of this website, entitiled "Shoulder Impingement Syndrome" and "Shoulder Impingement Surgery." When painful bursitis develops, the rotator cuff muscles--which normally participate in dynamically stabilizing the head of the humerus in the "socket" during overhead activity--become "lazy" if you will. This occurs partly in response to pain, and partly, over time, due to some deconditioning.Partial tears--"undersurface fraying"-- of the rotator cuff tendons may even develop. The net effect is that the "Impingement" type pain increases with use of one's arm overhead because there is subtle superior shift of the "ball" in the "socket". This then causes more "impingement" between the acromium and the rotator cuff insertion. The videos I mentioned earlier will help clarify.

PT can help decrease the pain with the short-term use of "modalities" such as heat and cold, iontophoresis etc. As pain settles a bit, a stretching and strengthening program is directed at restoring optimal function to the rotator cuff muscles and addressing capsular tightness. This may not happen after just a couple of visits. In fact, I usually tell my patients that 1-2 visits a week for 6-8 weeks is an adequate trial period. However, in some situations PT is not successful (less than 10-15%), in which case arthroscopic bursectomy becomes an option. In addition to removing the inflammed bursa, the CA (coracoacromial ligament) is released----since it is the major cause of "impingement."
In the absence of weakness/cuff tear----there is little downside to trying PT, because it is helpful in most cases.