Subacromial bursitis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray327.png|thumb|Shoulder bursa.]] | |||
[[File:Shoulder_joint_back-en.png|thumb|Shoulder anatomy, anterior.]] | |||
*Inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-acromial ligament, acromion, coracoid (the acromial arch) and from the deep surface of the deltoid muscle<ref>Salzman KL, Lillegard WA, Butcher JD (1997). "Upper extremity bursitis". Am Fam Physician 56 (7): 1797–806, 1811–2. PMID 9371010.</ref> | *Inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-acromial ligament, acromion, coracoid (the acromial arch) and from the deep surface of the deltoid muscle<ref>Salzman KL, Lillegard WA, Butcher JD (1997). "Upper extremity bursitis". Am Fam Physician 56 (7): 1797–806, 1811–2. PMID 9371010.</ref> | ||
*The subacromial bursa helps the motion of the supraspinatus tendon of the rotator cuff in activities such as overhead work. | *The subacromial bursa helps the motion of the supraspinatus tendon of the rotator cuff in activities such as overhead work. | ||
*Commonly occurs in individuals who participate in repetitive overhead activities (athletes, manual laborers, and factory workers)<ref>Faruqi T, Rizvi TJ. Subacromial Bursitis. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541096/</ref> | |||
==Clinical | ==Clinical Features== | ||
*Point tenderness at the anterolateral aspect of the shoulder below the acromion | |||
*Pain with abduction of arm between 60-120 degrees | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Shoulder DDX}} | {{Shoulder DDX}} | ||
==Diagnosis== | ==Evaluation== | ||
===Workup=== | |||
*'''Labs''' | |||
**Not usually indicated | |||
**Consider [[synovial fluid analysis]] if concern for [[septic arthritis]] | |||
*'''Imaging''' | |||
**Not necessary for diagnosis | |||
**Ultrasound may be helpful in measuring thickness of subacromial bursa | |||
**Consider shoulder X-ray to rule out [[fractures]], [[dislocations]], [[osteoarthritis]], etc. | |||
===Diagnosis=== | |||
*Typically a clinical diagnosis | |||
==Management== | ==Management== | ||
*Non-operative management | |||
**Rest, cold/heat, [[NSAIDs]] | |||
**(+/-) [[Corticosteroid injection]] | |||
==Disposition== | ==Disposition== | ||
*Most patients can be discharged and treated outpatient | |||
*Consider admission if overlying cellulitis, signs of sepsis, or unable to tolerate pain | |||
==See Also== | ==See Also== | ||
*[[Bursitis]] | *[[Bursitis]] | ||
*[[Rotator cuff tear]] | |||
==External Links== | ==External Links== | ||
*[https://www.physio-pedia.com/Shoulder_Bursitis Physiopedia - Shoulder Bursitis] | |||
==References== | ==References== | ||
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[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Sports Medicine]] | |||
Latest revision as of 18:50, 6 July 2022
Background
- Inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-acromial ligament, acromion, coracoid (the acromial arch) and from the deep surface of the deltoid muscle[1]
- The subacromial bursa helps the motion of the supraspinatus tendon of the rotator cuff in activities such as overhead work.
- Commonly occurs in individuals who participate in repetitive overhead activities (athletes, manual laborers, and factory workers)[2]
Clinical Features
- Point tenderness at the anterolateral aspect of the shoulder below the acromion
- Pain with abduction of arm between 60-120 degrees
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
Workup
- Labs
- Not usually indicated
- Consider synovial fluid analysis if concern for septic arthritis
- Imaging
- Not necessary for diagnosis
- Ultrasound may be helpful in measuring thickness of subacromial bursa
- Consider shoulder X-ray to rule out fractures, dislocations, osteoarthritis, etc.
Diagnosis
- Typically a clinical diagnosis
Management
- Non-operative management
- Rest, cold/heat, NSAIDs
- (+/-) Corticosteroid injection
Disposition
- Most patients can be discharged and treated outpatient
- Consider admission if overlying cellulitis, signs of sepsis, or unable to tolerate pain
See Also
External Links
References
- ↑ Salzman KL, Lillegard WA, Butcher JD (1997). "Upper extremity bursitis". Am Fam Physician 56 (7): 1797–806, 1811–2. PMID 9371010.
- ↑ Faruqi T, Rizvi TJ. Subacromial Bursitis. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541096/