Goubaa Mohamed MD Djerba Tunisia

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This is a 50-year-old male who was in a motor vehicle accident and first appeared in the emergency room 3 days later. He sustained a lacerations of her right shoulder.He is referred for ultrasound of shoulder. Ce patient âgé de 50 ans, victime d'un accident de motocycle, a été vu au service d'urgence 2 jours auparavant. Il a subit des lacération de son épaule droite. Il a été adressé pour une échographie de l'épaule.



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Anterior transverse (1, 3) and longitudinal (2)scan of the shoulder of this 50-year-old men demonstrate posttraumatic subdeltoid bursitis. A hypoechoic prominent bursitis (4) is shown. Also the long head of the biceps tendon is surrounding with fluid (with hypoechoic line above the biceps tendon (2)).

Les coupes transversales antérieur (1, 3) et longitudinales (2) de l'épaule de cet hommes de 50 ans démontrent une bursite. La bourse sous acromio-deltoïdienne est hopoéchogène et liquidienne. En outre une lame liquidienne entoure le tendon de biceps ( du liquide est visible au-dessus du tendon de biceps (2)).


Traumatic Subdeltoid bursitis bursite sous acromio-deltoïdienne traumatique ______


Subdeltoid Bursitis

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Introduction :
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.

Etiology :
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.

Clinique :
The patient presents with acute, severe, deep-seated local pain and weakness with shoulder movement in any plane but especially on abduction.

Sonography :
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) are suspected.

Treatment :
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).


Reference :
* 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. French.
* 7: Downing DS, Weinstein A. Ultrasound therapy of subacromial bursitis. A double blind trial. Phys Ther. 1986 Feb;66(2):194-9.