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  • Shoulder bursitis

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

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  • M75.80 Other shoulder lesions, unspecified shoulder

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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 younger patients ages 15 to 35)

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Signs and Symptoms

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  • Pain in anterior lateral shoulder with active movement involving primarily overhead ...

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