Bursal-sided rotator cuff tears

The subacromial bursa is a fluid-filled sac that assists in reducing friction between the acromion bone of the shoulder blade and the rotator cuff.  A bursal-sided rotator cuff tear is a type of injury affecting the rotator cuff, mainly on the side next to the subacromial bursa. A bursal-sided rotator cuff tear happens on the exterior surface of the rotator cuff tendons that face the bursa. This is not the same as the articular side tears, which happen on the inner surface of the joint capsule.

Bursal-sided rotator cuff tears are often caused by subacromial impingement syndrome, where repetitive overhead activities or any anatomical anomalies such as bone spurs lead to prolonged compression of the rotator cuff tendons against coracoacromial and acromion ligament. With time, such compression results in inflammation, wearing, and eventual tearing of the tendon fibers.

Causes of bursal-sided rotator cuff tears

Bursal-sided rotator cuff tears are caused because of several intrinsic and extrinsic factors. Intrinsic factors involve tendon degeneration due to age, where the tendon tissue weakens, thereby making it more vulnerable to injuries. Extrinsic factors include mechanical impingement and sudden trauma because of falls or lifting heavy things.

Athletes involved in overhead activities like baseball pitches or swimming are at risk of getting bursal-sided rotator cuff tears. In addition, bad posture, acromion shape variations, and scapular dyskinesia also enhance the risk of getting this kind of tear.

Symptoms

Bursal-sided rotator cuff tears cause shoulder pain, mainly on the outer aspect of your shoulder, that sometimes migrates towards your arm. The pain is aggravated because of overhead activities and is often accompanied by decreased motion, weakness, and difficulties in carrying out day-to-day activities like lifting objects or dressing. Another common symptom is night pain, which causes sleep disturbances.

Diagnosis

Diagnosis of bursal-sided rotator cuff tear is done through a proper clinical examination, which also includes specified tests such as Neer and Hawkins Kennedy impingement test.Imaging studies like magnetic resonance imaging have an important role in checking the extent and location of the rotator cuff tears. Ultrasound also helps for active assessment at the time of shoulder motion.

Treatment options for bursal-sided rotator cuff tears

Treatment can be conservative management or surgery. Conservative treatments include rest; physical therapies, with focus on strengthening and stretching exercises;  and corticosteroid injections for decreasing inflammation. But in case there is consistent pain along with functional disabilities after conservative treatment, then surgical intervention may be suggested.

Surgical treatment involves arthroscopic debridement and repairing of torn tendons. In arthroscopy, the surgeon removes the bursal tissue that is inflamed, including the bone spurs that cause impingement. In case there is a major impingement, sutures are used for reattachment of the torn tendon to the bone. Rehabilitation after surgery is important for restoring shoulder function and prohibiting relapse.

Conclusion

To conclude, a bursal-sided rotator cuff tear is a common injury of the shoulder, especially among those individuals who are involved in overhead activities. A proper understanding of its pathophysiology,  causes and different treatment options are important for efficient management and healthy recovery.

For enquiries and online appointments, send a message to www.BangaloreShoulderInstitute.com/contact

For informative videos related to Shoulder problems and their treatment options, Sports Injuries and other orthopedic conditions, visit the YouTube channel Bangalore Shoulder Institute – https://www.youtube.com/@BangaloreShoulderInstitute