- 726.19 Other specified disorders of bursae and tendons
in shoulder region
- M75.80 Other shoulder lesions, unspecified shoulder
- 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
- 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
- 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
- Mechanical wear under the coracoacromial
- Aberrant movement patterns due to rotator cuff and or periscapular
- 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
- Differential diagnosis from other shoulder pathologies that
may warrant surgical intervention is essential (rotator cuff tear,
superior labral tear).
- 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.
- 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 younger patients
ages 15 to 35)
- Pain in anterior lateral shoulder with active movement
involving primarily overhead ...
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