Arthroscopic Treatment of Shoulder Bursitis

Shoulder bursitis can be a persistent and painful condition, especially when it’s caused by unusual growths inside the shoulder’s natural cushioning structures. One rare but impactful form is when cartilage-like tissue forms in the shoulder’s bursa—the small sac that helps reduce friction under your shoulder blade. This condition is called synovial chondromatosis, and in some cases, it can lead to damage in the rotator cuff.

How Common It Is and Who Gets It? (Epidemiology)

Synovial chondromatosis is a rare condition, often affecting individuals who have chronic shoulder issues or repetitive overhead movements. While it can occur in any joint, it is particularly problematic in the shoulder, where it can lead to inflammation, restricted motion, and rotator cuff damage if left untreated.

Why It Happens – Causes (Etiology and Pathophysiology)

The condition occurs when the synovium, the lining of the joint or bursa, starts producing extra cartilage that breaks off into the joint or bursal space. These loose bodies can cause significant irritation, friction, and, over time, damage to the surrounding tissues, including the rotator cuff. The cause of synovial chondromatosis remains unclear, though it is thought to arise from repetitive microtrauma or changes in the synovial lining.

How the Body Part Normally Works? (Relevant Anatomy)

The bursa in the shoulder is a small, fluid-filled sac that helps reduce friction between the shoulder blade and the arm bone, allowing for smooth motion during arm movement. In synovial chondromatosis, abnormal cartilage growth within the bursa creates loose bodies that can disrupt normal shoulder function and lead to pain, stiffness, and weakness.

What You Might Feel – Symptoms (Clinical Presentation)

Symptoms of shoulder bursitis caused by synovial chondromatosis include persistent pain, limited range of motion, and difficulty with overhead or repetitive movements. As the condition progresses, the presence of loose cartilage bodies can also lead to rotator cuff irritation or tears, resulting in increased pain and dysfunction, particularly with reaching or rotating the arm.

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis begins with a physical examination and patient history. Imaging studies such as X-rays and MRI are essential for confirming the presence of loose bodies and identifying any associated rotator cuff damage. In some cases, a magnetic resonance arthrogram (MRA) may be used to provide clearer imaging of the bursa and rotator cuff.

Classification

Synovial chondromatosis is classified based on the extent of the cartilage nodules within the joint or bursa. The condition may involve multiple loose bodies of varying sizes, leading to varying degrees of irritation and damage to the surrounding structures. The severity of the condition determines the treatment approach.

Other Problems That Can Feel Similar (Differential Diagnosis)
Other conditions that can cause shoulder pain and limited range of motion include subacromial bursitis, rotator cuff tears, or shoulder impingement syndrome. Imaging studies are necessary to differentiate synovial chondromatosis from these conditions and accurately diagnose the presence of loose bodies.

Treatment Options

Non-Surgical Care

• Physical therapy focused on strengthening the shoulder muscles and improving flexibility
• Rest and activity modification to avoid aggravating the condition
• Anti-inflammatory medications or corticosteroid injections for pain relief

Surgical Care

• Arthroscopic surgery to remove the loose cartilage bodies from the bursa
• Subacromial decompression (acromioplasty) to reduce friction and pressure on the rotator cuff
• In some cases, rotator cuff repair if damage is extensive

Recovery and What to Expect After Treatment

After arthroscopic surgery, patients typically wear a sling for a short period to protect the shoulder, followed by physical therapy to restore range of motion and strength. Full recovery generally takes several months, with most patients returning to normal activities within four to six months, depending on the extent of the surgery and rehabilitation.

Possible Risks or Side Effects (Complications)

Possible complications include infection, bleeding, stiffness, and the recurrence of symptoms if the underlying condition is not fully treated. In rare cases, there may be incomplete relief of pain or continued irritation of the rotator cuff.

Long-Term Outlook (Prognosis)

The prognosis for patients undergoing arthroscopic treatment for synovial chondromatosis is generally positive, with most experiencing significant relief from pain and improved shoulder function. However, recovery time varies depending on the severity of the condition and the patient’s adherence to a rehabilitation program.

Out-of-Pocket Cost

Medicare

CPT Code 29826 – Arthroscopic Shoulder Bursitis Treatment (Arthroscopic Subacromial Decompression and Bursectomy): $40.07

Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield usually cover that 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce patient financial responsibility.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it serves as a secondary payer. These plans generally cover any remaining coinsurance or small deductibles, which typically range from $100 to $300, depending on your plan and provider network.

Workers’ Compensation

If your shoulder bursitis and subsequent surgery are related to a work-related injury, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your shoulder bursitis is due to an automobile accident, No-Fault Insurance will typically cover the full cost of treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment, depending on your insurance policy.

Example

David Lewis underwent arthroscopic shoulder treatment (CPT 29826) for chronic shoulder bursitis. His estimated Medicare out-of-pocket cost was $40.07. Since David had supplemental insurance through Blue Cross Blue Shield, his remaining balance was fully covered, leaving him with no out-of-pocket expenses for the procedure.

Frequently Asked Questions (FAQ)

Q. What is shoulder bursitis?
A. Shoulder bursitis is inflammation of the bursa, a fluid-filled sac that reduces friction between tissues in the shoulder.

Q. What causes shoulder bursitis?
A. It can be caused by overuse, trauma, impingement, calcium deposits, or infection.

Q. What are the symptoms of shoulder bursitis?
A. Symptoms include pain, swelling, and limited range of motion in the shoulder.

Q. How is shoulder bursitis diagnosed?
A. Diagnosis is based on a clinical exam and may include imaging such as X-rays or MRIs.

Q. What non-surgical treatments are available for shoulder bursitis?
A. Treatments include rest, ice, anti-inflammatory medications, physical therapy, corticosteroid injections, and activity modification.

Q. When is surgery considered for shoulder bursitis?
A. Surgery is considered when non-operative treatments fail to relieve symptoms.

Q. What is arthroscopic treatment for shoulder bursitis?
A. Arthroscopic treatment involves removing the inflamed bursa and smoothing any bone spurs through small incisions using a camera and instruments.

Q. What are the benefits of arthroscopic treatment?
A. It is minimally invasive, allows faster recovery, and involves less pain and scarring compared to open surgery.

Q. What happens during the arthroscopic procedure?
A. A small camera and instruments are inserted into the shoulder to remove the inflamed bursa and any bone spurs causing impingement.

Q. Is the rotator cuff tendon repaired during this procedure?
A. If the rotator cuff is torn, it can be repaired during the same arthroscopic surgery.

Q. What is the recovery time after arthroscopic treatment of shoulder bursitis?
A. Recovery time varies but typically includes physical therapy and a return to full activity in a few weeks to months.

Q. What are the risks of arthroscopic surgery for bursitis?
A. Risks include infection, bleeding, stiffness, and incomplete symptom relief.

Q. Will I need physical therapy after the procedure?
A. Yes, physical therapy is usually recommended to restore range of motion and strength.

Q. How long will I need to wear a sling after surgery?
A. A sling may be worn for a few days to a few weeks, depending on the extent of the procedure.

Q. Can shoulder bursitis return after arthroscopic treatment?
A. While the inflamed bursa is removed, symptoms can recur if the underlying cause is not addressed.

Summary and Takeaway

Shoulder bursitis, particularly when caused by synovial chondromatosis, can be a persistent and painful condition that may lead to rotator cuff damage. Imaging is essential for diagnosing underlying causes, such as loose bodies in the bursa. Arthroscopic surgery is an excellent treatment option that provides a minimally invasive approach to remove debris, decompress the shoulder joint, and promote healing. With proper treatment and rehabilitation, patients can expect significant relief and a return to normal activities, even after long-standing symptoms. If you’re experiencing chronic shoulder pain, consulting a specialist is crucial for proper diagnosis and treatment.

Clinical Insight & Recent Findings

Recent advancements in arthroscopic techniques have significantly improved outcomes for patients with shoulder bursitis, especially those with rare causes like synovial chondromatosis. Studies show that arthroscopic surgery provides excellent pain relief and accelerates recovery compared to traditional open surgery.

Who Performs This Treatment? (Specialists and Team Involved)

Orthopedic surgeons specializing in shoulder conditions typically perform arthroscopic procedures for bursitis. Rehabilitation specialists, including physical therapists, play a key role in recovery.

When to See a Specialist?

If you have persistent shoulder pain that does not improve with conservative treatments such as physical therapy or injections, it’s important to see a specialist for further evaluation.

When to Go to the Emergency Room?

Seek emergency care if you experience severe shoulder pain following a traumatic injury or if you notice signs of infection, such as fever or redness at the surgical site.

What Recovery Really Looks Like?

Post-surgery recovery involves using a sling for protection, followed by a structured rehabilitation program to restore shoulder function. Full recovery generally takes a few months, depending on the extent of the procedure and the patient’s progress with physical therapy.

What Happens If You Ignore It?

Left untreated, shoulder bursitis can lead to chronic pain, limited mobility, and potential damage to the rotator cuff or other structures. Early intervention with proper diagnosis and treatment can prevent these complications.

How to Prevent It?

To prevent recurrence of bursitis, it’s important to manage activities that put strain on the shoulder, maintain good posture, and perform strengthening exercises for the rotator cuff and surrounding muscles.

Nutrition and Bone or Joint Health

A diet rich in calcium, vitamin D, and omega-3 fatty acids can support joint health, reduce inflammation, and aid recovery after surgery.

Activity and Lifestyle Modifications

Avoid activities that strain the shoulder joint, particularly those involving overhead lifting or repetitive movements. Strengthening the rotator cuff and scapular stabilizers can help prevent instability.