Bursitis, subacromial

• Shoulder bursitis

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

• M75.80 Other shoulder lesions, unspecified shoulder

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation

Description

• 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.

Essentials of Diagnosis

• 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).

General Considerations

• 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.

Demographics

• 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)

Signs and Symptoms

• Pain in anterior lateral shoulder with ...