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"The Shoulder" Demo


Chronic degenerative bursitis : The complaints recur after initial improvement


1. Treat with increasing interval

It is recommended to administer the injections with increasing intervals (cfr I.A. injections ): 10 days - 2 weeks - 3 weeks - 6 weeks.

2. Causal treatment

With repeated relapses, one should consider a causal treatment,

A. Check whether structural (anatomical) alterations cause the relapsing impingement of the subacromial structures. Structural causes may be:

  • Degenerative osteophytes at the level of the acromioclavicular joint
  • Abnormal form or degenerative deformity of the acromion
  • Deformities at the level of the coracoid or abnormal thickening of the coraco-acromial ligament
  • Deformities at the level of the tuberculum majus of the humerus
  • If an anatomical deviation causes the degenerative bursitis to relapse, then, a definite solution can be offered through a surgical decompression with removal of the front and lower part of the acromion and of the van het coraco-acromial ligament.

    B. Check to see whether any functional cause for the relapsing impingement can be found:

  • Presence of a "minor" shoulder instability
  • Loss of the normal depression mechanism/(?) of the head of the humerus during elevation; This can be caused by an imbalance between the ab- and adductors during the elevation.
  • If a functional cause for the relapsing bursitis is found, then, a treatment with functional, proproceptive and muscle strenghtening exercices may be started.