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Acute subdeltoid bursitis

Contents

Definition

  • Inflammation of the bursa of the shoulder
  • One of the most painful pathologies within orthopedics

Causes

  • No apparent underlying cause for development

Development

  • Quick onset
  • Without treatment it is usually dissolved within 6 weeks

Indications

  • Even slight movement of the shoulder is incredibly painful
  • High amount nighttime pain causing problems with sleep
    • This can also be apparent when looking at the patient’s face
  • Also pain at rest
  • Patient keeps the arm close to the body, not willing to move it as it will provoke pain

Development

  • Day 1-3
    • At onset the pain increases swiftly to it’s maximum within 3 days
      • After 3 days the pain is severe radiating to the entire c5 dermatome
  •  Day 7-10
    • Pain starts to decrease after 7-10 days
  • Week 2-6
    • The last 3-4 weeks the feeling is more of an ache than severe pain
  •  Week 4-6
    • The pain will disappear completely usually after 4-6 weeks, and range of motion returns to normal
      • During the end of the period a painful arc may be found again

Examination

  • Difficult to perform as the patient is unwilling to move the arm
    • Active and passive elevation almost impossible
  • Clear limitation of passive abduction
  • Other passive movements also painful, but in some cases only barely limited
  • Also pain during resisted movements, especially:
    • Isometric abduction
    • Isometric lateral rotation
  • At early stage (first days), painful arc may be present
  • Palpation of the upper arm and the superficial part of the bursa is painful and sometimes swollen