Subdeltoid Bursitis – Diagnosis and Treatment

The subdeltoid bursa is located under the acromion , between the deltoid muscle and the shoulder capsule. It is a single or several-part fluid-filled thin vesicle. Its inflammation is called subdeltoid bursitis. It can be injured both in acute injuries and as a result of repetitive microtraumas. Acute injuries usually occur during sports or due to falls. Repetitive traumas, on the other hand, may develop due to activities such as carrying heavy bags, working with arms up, throwing. Microtraumas can cause injury, tear, and inflammation of the subdeltoid bursa in the shoulder rotator muscles. If the problem becomes chronic, there may also be calcification in the bursa.

In subdeltoid bursitis, pain may be felt in the movement of the shoulder in all directions, but the movement of raising the arm to the side (abduction) is most painful. Pain is located where the subdeltoid bursa is, may radiate to the upper third of the arm where the deltoid muscle attaches to the humeral bone. It may not be possible to lie on the affected arm and sleep. When getting out of bed, a sharp pain and a feeling of being stuck can be felt when the arm is opened to the side.

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Signs and Symptoms

When you press on the bone protrusion called acromion on the upper part of the shoulder, a sensitive and painful area is detected. Sometimes the deltoid muscle may feel swollen and edematous due to increased fluid in the bursa. Passive raising and inward rotation of the shoulder causes pain. Rotator cuff tear may mimic or coexist with subdeltoid bursitis.

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Calcification, which is a sign of chronic inflammation, can be seen in the bursa and related structures on X-ray films of the shoulder. With magnetic resonance imaging, problems such as tendinitis, ligament damage, rotator cuff tear, bursitis can be diagnosed. Ultrasound allows examination of the shoulder joint in motion. Depending on the signs and symptoms, tests such as complete blood count, erythrocyte sedimentation rate, and anti-nuclear antibodies may be required. If a primary or metastatic cancer involving the shoulder is suspected, bone scintigraphy may be performed. Local injection into the subdeltoid bursa can be applied for both diagnosis and treatment.

Differential diagnosis

Subdeltoid bursitis is one of the most common causes of shoulder pain . Osteoarthritis (calcification), rheumatoid arthritis, rotator cuff syndrome are other common causes of shoulder pain. These problems may coexist with subdeltoid bursitis. Less common causes of shoulder pain include connective tissue diseases, crystal deposition ( gout , pseudogout), infection, Lymedisease, villonodular synovitis. In acute infection, symptoms that affect the whole body such as fever and fatigue can be found. To diagnose shoulder joint infection, a sample of joint fluid is taken and analyzed. Cell counting, microscopic examination and culture are performed. Antibiotics are given to treat the infection and surgical debridement may be required. Connective tissue and rheumatic diseases mostly involve more than one joint and specific markers in the blood may be positive.

Subdeltoid Bursitis Treatment

Pain and limitation of movement due to subdeltoid bursitis are initially treated with non-steroidal anti-inflammatory or cyclooxygenase-2 inhibitor drugs and physical therapy. Methods such as hot or cold applications, electrotherapy, ultrasound therapy, exercises are used in physical therapy. If adequate healing is not achieved with these, local anesthetic and corticosteroid injection into the bursamakes. The injection is administered using sterile technique. Mix 4 mL of 0.25% bupivacaine and 40 mg of methylprednisolone (other drug combinations can also be used). The injection site is determined at the midpoint of the outer edge of the acromion. The needle passes through the skin and subcutaneous tissues and reaches the bursa. If it hits the bone, it is reoriented by pulling back slightly. Before the injection is given, negative pressure is created by pulling the plunger back slightly to make sure it is not in the blood vessel. After confirming that it is not in the blood vessel, the content is slowly introduced. During this time, much resistance should not be felt. If ultrasonography guidance is used, the success of the needle in the right place increases. Complications such as bleeding and bruising are reduced if pressure and cold application are applied after the injection. The pain may intensify for a few days.

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If severe calcific bursitis does not respond to the above treatments, the subdeltoid bursa can be surgically removed.

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