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Chronic subdeltoid bursitis

Contents

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/

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652754/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867080/