From the Guidelines
Glenohumeral joint effusion, tendinitis, bursitis, and bone marrow edema are typically caused by acute injury, repetitive overuse, or underlying inflammatory conditions, as supported by the most recent evidence from 1.
Causes of Glenohumeral Joint Pathologies
The causes of these conditions can be multifactorial, including:
- Acute trauma such as falls or direct impacts, which can cause immediate damage to the shoulder structures 1
- Repetitive overhead activities, particularly in sports like swimming, baseball, or tennis, leading to chronic inflammation and tissue damage over time
- Inflammatory conditions including rheumatoid arthritis, gout, or calcium crystal deposition, which can trigger these shoulder pathologies
- Infections, though less common, may cause joint effusion and surrounding inflammation
- Age-related degenerative changes, which contribute to these conditions as tissues become more vulnerable to injury with decreased elasticity and blood supply
Pathophysiology and Treatment
These conditions occur because inflammation triggers fluid accumulation in the joint space (effusion), irritation of tendon sheaths (tendinitis), inflammation of fluid-filled cushioning sacs (bursitis), and increased fluid in bone marrow (edema) as part of the body's healing response. Treatment typically involves:
- Rest, ice, anti-inflammatory medications (such as ibuprofen 400-800mg three times daily with food for 1-2 weeks)
- Physical therapy and activity modification
- For persistent cases, corticosteroid injections may be considered, as mentioned in the context of osteonecrosis treatment in 1
Importance of Early Diagnosis
Early diagnosis of osteonecrosis, which can be a cause of glenohumeral joint pathologies, is crucial to exclude other causes of patient’s pain and to allow for possible early surgical prevention to prevent articular collapse and the need for joint replacements, as highlighted in 1.
From the Research
Causes of Glenohumeral Joint Effusion, Tendinitis, Bursitis, and Bone Marrow Edema
- Glenohumeral instability, which can be caused by traumatic dislocations or instability events associated with acute labral tears, can lead to joint effusion, tendinitis, and bursitis 2
- Rotator cuff tears, which can occur after shoulder dislocations, may cause persistent pain, dysfunction, instability, and degenerative changes, including tendinitis and bursitis 3
- Glenohumeral joint osteoarthritis, which can be caused by traumatic injuries, rotator cuff pathology, glenohumeral instability, glenoid dysplasia, and osteonecrosis, can lead to joint effusion, tendinitis, and bursitis 4, 5
- Adhesive capsulitis, also known as frozen shoulder, can cause pain and stiffness in the shoulder joint, leading to tendinitis and bursitis 4
- Trauma and overuse can damage the stabilizers of the glenohumeral joint, leading to subluxation or dislocation and eventually recurrent instability, which can cause bone marrow edema 6
Associated Conditions
- SLAP tears, pan-labral tears, and multidirectional instability are special shoulder conditions that are associated with shoulder instability and can cause joint effusion, tendinitis, and bursitis 2
- Rotator cuff tears and glenohumeral instability are often associated with each other and can cause persistent pain, dysfunction, and degenerative changes 3
- Glenohumeral joint osteoarthritis is often associated with other conditions, such as rotator cuff pathology and glenoid dysplasia, which can contribute to the development of joint effusion, tendinitis, and bursitis 5