The subacromial bursa
is a large structure that lies the acromion and coracoacromial
ligament and separates the ligament from the supraspinatus muscle
and rotator cuff. It does not communicate with the shoulder joint
unless the supraspinatus tendon is torn.
Burstis may occur as a result of several causes :
· acute trauma.
· chronic friction (overuse injuries).
· crystal deposition (gout, pseudogout).
· Infection : tuberculosis (1) or other infections (4).
· systemic diseases : rheumatoid arthritis (6), ankylosing spondylitis,
psoriatic arthritis, scleroderma, systemic lupus erythematosus,
pancreatitis, Whipple disease, oxalosis, uremia, hypertrophic
pulmonary osteoarthropathy, and idiopathic hypereosinophilic syndrome.
The patient presents with acute, severe, deep-seated local pain
and weakness with shoulder movement in any plane but especially
The shoulder ultrasonography is the only modality that can visualize
and characterize synovial and bursa disease, without radiographic
contrast, and when necessary, US-guided aspiration and biopsy
can be performed. The subacromial-subdeltoid bursa is imaged as
a hypoechoic line, 1-2 mm thick with a variable amount of peribursal
echogenic fat, between the deltoid muscle and the supraspinatus
and infraspinatus tendons (1).
The most common indication for shoulder ultrasonography is the
diagnosis of rotator cuff disease. However, there is a spectrum
of non-rotator cuff abnormalities that are amenable to ultrasonography
examination, including instability of the biceps tendon, glenohumeral
joint, and acromioclavicular joint; arthropathies and bursites
(inflammatory diseases, degenerative and infiltrative disorders,
infections) (2 , 3).
Bursitis : The bursa was prominent (more then 2 mm) and Ultrasography
shows abnormal hopoechogenic or echogenic (blood) fluid within
the subdeltoid bursa, which shows hyperemia suggestive of acute
bursitis. Increased fluid in subacromial-subdeltoid bursa usually
accompanies rotator cuff full thickness tears. the diagnosis of
bursitis will be evoked when The difference between the affected
and the sound bursa thickness is bigger than 1 mm associated with
asymmetries of one of the following parametres: echogenicity,
echostruture or rhythm (5). Radiography is usually not helpful
in acute bursitis unless other pathologies (fractures, dislocations)
Most patients with bursitis can be treated conservatively. Conservative
treatment aims to reduce inflammation. Conservative treatment
includes rest, cold and heat treatments, nonsteroidal anti-inflammatory
drugs, elevation, bursal aspiration, and intrabursal steroid injections.
Put affected shoulder at rest , but shoulders should not be immobilized
for more than a few days because of the risk of adhesive capsulitis.
Also, ultrasound is used to treat patients with subacromial bursitis
but the results suggest that US is of little or no benefit (7).
* 1: Moosmayer S, Heir S, Aaser P, Smith HJ. [Ultrasound
examination of the shoulder--a method description] Tidsskr Nor
Laegeforen. 2004 Jan 22;124(2):177-80. Norwegian.
* 2: Martinoli C, Bianchi S, Prato N, Pugliese F, Zamorani MP,
Valle M, Derchi LE. US of the shoulder: non-rotator cuff disorders.
Radiographics. 2003 Mar-Apr;23(2):381-401; quiz 534. Review.
* 3: Bouffard JA, Lee SM, Dhanju J. Ultrasonography of the shoulder.
Semin Ultrasound CT MR. 2000 Jun;21(3):164-91. Review.
* 4: Rutten MJ, van den Berg JC, van den Hoogen FH, Lemmens JA.
Nontuberculous mycobacterial bursitis and arthritis of the shoulder.
Skeletal Radiol. 1998 Jan;27(1):33-5.
* 5: Fernandes MS, Pinto AC. [Ultrasonographic diagnosis of the
pathology of the rotator cuff and subacromial bursa: criteria]
Acta Med Port. 1994 Apr;7(4):211-20. Portuguese.
* 6: Vicens JL, Flageat J, Eulry F, Pattin S, Doury P. [Shoulder
bursitis in rheumatoid polyarthritis] J Radiol. 1989 Nov;70(11):649-51.
* 7: Downing DS, Weinstein A. Ultrasound therapy of subacromial
bursitis. A double blind trial. Phys Ther. 1986 Feb;66(2):194-9.