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Condition/Disorder Synonym

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  • Shoulder bursitis

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ICD-9-CM Code

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  • 726.19 Other specified disorders of bursae and tendons in shoulder region

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ICD-10-CM Code

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  • M75.80 Other shoulder lesions, unspecified shoulder

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Preferred Practice Pattern1

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Key Features

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Description

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  • Shoulder pain and dysfunction due to compression and abrasion of the subacromial bursa beneath the coracoacromial arch

  • The coracoacromial arch consists of the undersurface of the acromion, coracoacromial ligament as well as the undersurface of the acromioclavicular (AC) joint.

  • Subacromial bursa lies beneath the acromion and serves to cushion the rotator cuff tendons from the osseous undersurface of the acromion.

  • Subacromial bursitis results when the subacromial bursa fills with blood and serous fluid as response to either acute or repeated micro-trauma (compression and/or abrasion).

    • Fibrotic changes in the bursa can result from chronic impingement or stress.

    • Increase in bursa size decreases volume of subacromial space and can lead to subacromial impingement syndrome.

  • Subacromial bursitis leads to subacromial impingement syndrome, which is the most commonly diagnosed shoulder problem and likely has numerous potential mechanisms that can impact both treatment and prognosis.

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Essentials of Diagnosis

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  • Compression or abrasion of the subacromial bursa can be either acute, involving a fall, usually on a flexed elbow, or chronic, which can be more multifactorial in nature.

  • Chronic (repeated micro-trauma) mechanism thought to be related to intrinsic and/or extrinsic mechanisms

    • Extrinsic mechanisms (extratendinous, cause decreased sub-acromial space and subsequent micro-trauma with repetitive movements)

      • Mechanical wear under the coracoacromial arch

      • Aberrant movement patterns due to rotator cuff and or periscapular muscular dysfunction

      • Capsular abnormalities

      • Capsular tightness (particularly posterior capsule)

      • Capsular laxity (poor humeral head dynamic control)

      • Sub-optimal posture

      • Muscle imbalances

      • Overuse/repetitive motions occurring at more than 90 degrees of elevation

    • Intrinsic factors (directly associated with the narrowing of the sub-acromial space)

      • Vascular supply/changes to the cuff tendons

      • Acromial morphology (structural variations).

        • Type I (flat)

        • Type II (curved)

        • Type III hooked)

      • Degenerative and/or structural changes to the AC joint

  • Other trophic changes in the coracoacromial arch or humeral head

  • Differential diagnosis from other shoulder pathologies that may warrant surgical intervention is essential (rotator cuff tear, superior labral tear).

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General Considerations

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  • Commonly diagnosed and associated with presence of other orthopedic pathologies: subacromial impingement syndrome, rotator cuff pathology, labral pathology.

  • Commonly associated with repeated overhead or overuse activities.

  • Full history of symptoms, medical history screening, and differential shoulder orthopedic examination will ensure appropriate diagnosis.

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Demographics

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  • Occurs primarily in adults but can occur in teenagers participating in overhead athletics or with trauma

  • Similar demographics as subacromial impingement syndrome

    • Primary impingement (generally occurs in patients ages 40 and older)

    • Secondary impingement (generally occurs in ...

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