Subacromial Bursitis(Lowe)

Question 1

What is Subacromial Bursitis?

Answer 1

-bursa can be compressed under coracoacromial arch from acute trauma or repetitive stress

Question 2

Characteristics

Answer 2

• bursa under the acromion to prevent compression of the soft tissues against bone; may have a small division and considered two separate bursae; upper portion is the subacromial bursa, distal portion under the deltoid muscle is sub-deltoid bursa; when arm is fully abducted, bursa moves under acromion process

-pressure is primary cause of bursitis, inflammation can result from autoimmune diseases (rheumatoid arthritis, infection, gout, calcific deposits, other systemic disorders)

-symptoms and patterns of pain are the same as for impingement; pain reported in the lateral or anterior region of GH joint; associated with flexion, abduction or medial rotation when arm flexed; night pain due to tissue compression, difficult to identify specific location of pain

-painful arc during abduction: pain only in portion of movement; begins soon after initiating abduction and continue to about 135°; no pain after this point; occurs because irritated bursa is compressed and then moves proximally under acromion and no longer compressed; other tissues (rotator cuff tears, tendinosis, calcific tendinitis) can also produce a painful arc

-can develop from repetitive compressive actions or impact trauma with high compressive load; from repetitive overhead motion of arm or long periods of arm held overhead

Question 3

History:

Answer 3

• dull shoulder ache, activities involving repetitive abduction or flexion with medial rotation of shoulder; gradual but traumatic injuries can alter GH mechanics and cause acute symptoms; ask about systemic disorders, infectious conditions, or autoimmune pathologies

-weakness with certain movements is likely

-ask about age at onset; more typical as patient ages

Question 4

Observation:

Answer 4

swelling not visible; alterations in movement or apprehension during AROM/PROM; limitation to smooth movement with abduction

Question 5

Palpation:

Answer 5

may not elicit tenderness because of location under acromion process; if subdeltoid portion involved pain with palpation inferior to the lateral edge of acromion process near greater tubercle of humerus; tender and hypertonic muscles possible

Question 6

Range of Motion and Resistance Testing

Answer 6

AROM: pain with further compression of bursa, irritated by abduction and flexion; weakness or lack of smoothness with motion due to reflex muscular inhibition; painful arc during abduction

PROM: pain with abduction and forward flexion, same as AROM, painful arc possible

MRT: no increase in pain due to no additional compression by muscle contraction; way to differentiate bursitis from supraspinatus impingement or rotator cuff tears/tendinosis; weakness during resisted abduction/flexion may result from reflex muscular inhibition if bursa compressed at starting position

Question 7

Differential Evaluation:

Answer 7

shoulder impingement syndrome, rotator cuff tears, tendinosis, calcific tendinitis, suprascapular neuropathy, frozen shoulder/adhesive capsulitis, acromioclavicular joint injury, bicipital tendinosis, brachial plexus pathology, cervical disc radiculopathy, myofascial trigger point pain, thoracic outlet syndrome, labral damage

Question 8

Suggestions for Treatment:

Answer 8

reduce inflammation, alleviate additional pressure, oral anti-inflammatory medication or corticosteroid injections; soft-tissue techniques to relax shoulder girdle muscle, reduce hypertonicity; can use deep, moist heat to decrease muscle tension because bursa is deep to acromion process