Chronic subdeltoid bursitis

Definition

• Inflammation of the subdeltoid bursa
  • The bursa serves to lubricate joints and body surfaces exposed to higher degree of wear and friction
• A chronic subdeltoid bursitis is chronic at onset, and is not a further development of an acute subdeltoid burisitis
• Can be observed in isolation, but often seen in association with lesions of the rotator cuff muscles
• There is far less pain with chronic subdeltoid bursitis than acute subdeltoid burisitis
• The subdeltoid and subacromial bursa are anatomically the same bursa, but the terms are often used to differentiate which part of the bursa is affected
  • A chronic subdeltoid bursitis is therefore often called subacromial bursitis

Causes

• Any process that causes inflammation of the bursa can lead to bursitis. Typical situations are:
  • Subacromial impinchment
  • Repetetive overhead activities/overuse
  • Direct trauma
    • Such as falling on shoulder
  • Crystal deposition
  • Subacromial hemorrhage
  • Infection
  • Autoimmune diseases (1)

Development

• Can persist for the patient’s lifetime if not treated properly
• May develop spontaneously or after injury
• A chronic subdeltoid bursitis is chronic at onset, and is not a further development of an acute subdeltoid burisitis
• Inflammation and adhesion is formed in the space between the acromial and tendinous parts of the bursa together with an increased amount of substance P in the bursal wall
• If the injury heals, the same injury may recur at a later time

Indications

• May affect any age
• Pain at the anterolateral aspect of the shoulder
  • Pain is within the C5 dermatome
• Pain may vary, sometimes during activity, but can also be felt at rest or sometimes continuously

Examination

• Clinical picture may vary greatly
• Painful arc
  • At times the only symptom
  • A clearly positive painful arc makes the diagnosis more probable, often it may be only slightly positive
• Passive elevation – painful
  • May be present, but not necessarily positive
• Resisted abduction - painful
  • May be present, but not necessarily positive
• Resisted lateral rotation
  • May be present, but not necessarily positive
• On rare occasions abduction or medial rotation may be somewhat limited
• Resisted movements may be painful, or without pain

Considerations

• The subscapularis acts together with infraspinatus, latissimus dorsi and teres major as a depressor of the humeral head during abduction so that there is more space for the movement avoiding subacromial impingement ¹²

References

1. https://www.ncbi.nlm.nih.gov/books/NBK541096/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867080/