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Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study

Abstract

Purpose

The presence of the subacromial-subdeltoid (SASD) bursa inflammation has recently been proposed as a primary radiologic factor predicting persistent limitation and pain in operated patients. The aim of the study was to verify the hypothesis that pain, or increased shoulder pain, could be associated with SASD bursitis not only in operated patients but also in general population.

Methods

A consecutive series of 1940 shoulder ultrasound examinations were performed by our Department over a 5-year period using linear multi-frequency probes. All reports of examination executed for shoulder pain were reviewed. The video clips were independently reviewed by two radiologists: effusion in the SASD bursa and the presence of other pathological conditions were evaluated and confirmed.

Results

A total of 1147 shoulder video clips were re-evaluated, and 1587 pathologies were detected; 65.5 % of patients had only one pathology, 30.4 % had two and 4.1 % presented three pathologies. The difference between the group with and without effusion is statistically significant for acromioclavicular joint arthritis, supraspinatus tendon calcific tendinopathy, full-thickness and superficial tear of the supraspinatus, traumas and rheumatoid arthritis with a p value <0.01.

Conclusions

Our study shows that the effusion in the SASD bursa is frequently associated with shoulder pain often independently from the underlying pathology; further studies are needed to confirm the statistical significance of this relationship by clarifying possible confounding factors.

Riassunto

Scopo del lavoro

La presenza di alterazioni flogistiche a livello della borsa subacromiondeltoidea (BSAD) è stata recentemente proposta come fattore principale per predire la comparsa di dolore e limitazione funzionale nei Pazienti operati a livello della spalla. Lo scopo del nostro studio è di verificare l’ipotesi che il dolore, o l’incremento dello stesso, sia associato con la flogosi della BSAD non solo nei Pazienti operati ma anche nella popolazione generale.

Materiali e Metodi

In 5 anni nel nostro dipartimento sono state eseguite, utilizzando esclusivamente sonde lineari multifrequenza, 1940 ecografie della spalla. Tutti gli esami aventi come indicazione il dolore sono stati selezionati. I videoclip degli esami selezionati sono stati rivalutati da due radiologi indipendentemente: è stata in tal modo confermata la presenza di versamento nella BSAD e di altri reperti patologici.

Risultati

Sono stati rivalutati i videoclip di 1147 ecografie di spalla. Sono state individuate 1587 alterazioni patologiche; il 65.5 % dei Pazienti presentava unicamente un riscontro patologico, il 30.4 % ne presentava due e il 4.1 % ne presentava 3. La differenza tra gruppo con e senza versamento è statisticamente significativa (p value <0.01) in caso di artrosi acromionclaveare, tendinopatia calcifica del sovraspinato, lesioni a tutto spessore e del versante bursale del tendine del sovraspinato, nei traumi e nell’artrite reumatoide.

Conclusioni

Il nostro studio mostra come il versamento nella BSAD sia frequentemente associato con il dolore di spalla spesso indipendentemente dalla patologia sottostante; ulteriori studi sono necessari per confermare tale relazione e chiarire l’influenza di possibili fattori confondenti.

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Conflict of interest

The authors have nothing to disclose.

Ethical standards

Studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Author information

Correspondence to Chandra Bortolotto.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 11: Video 10 Bursal rupture (after dislocation) (MPG 1092 kb)

Supplementary material 12: Video 11 Septic bursitis (MPG 2846 kb)

Supplementary material 14: Video 12B Pigmented villonodular synovitis—Color Doppler (MPG 2494 kb)

Supplementary material 13: Video 12A Pigmented villonodular synovitis—B-Mode (MPG 2276 kb)

Supplementary material 1: Video 1A Acromioclavicular joint arthritis (MPG 1772 kb)

Supplementary material 2: Video 1B Osteoarthritis and SASD bursitis (MPG 1782 kb)

Supplementary material 3: Video 2 Rheumatoid arthritis (MPG 1312 kb)

Supplementary material 4: Video 3 Partial supraspinatus tendon tear (MPG 2118 kb)

Supplementary material 5: Video 4 Complete supraspinatus tendon tear (MPG 864 kb)

Supplementary material 6: Video 5 Bursitis as a complication in the reconstruction of the supraspinatus tendon (MPG 664 kb)

Supplementary material 7: Video 6 Calcium-related bursitis (MPG 858 kb)

Supplementary material 8: Video 7 Acute shoulder trauma (MPG 4670 kb)

Supplementary material 9: Video 8 Acute shoulder trauma (MPG 598 kb)

Supplementary material 10: Video 9 Acute shoulder trauma (Hill-Sachs lesion) (MPG 998 kb)

Supplementary material 11: Video 10 Bursal rupture (after dislocation) (MPG 1092 kb)

Supplementary material 12: Video 11 Septic bursitis (MPG 2846 kb)

Supplementary material 14: Video 12B Pigmented villonodular synovitis—Color Doppler (MPG 2494 kb)

Supplementary material 13: Video 12A Pigmented villonodular synovitis—B-Mode (MPG 2276 kb)

Supplementary material 1: Video 1A Acromioclavicular joint arthritis (MPG 1772 kb)

Supplementary material 2: Video 1B Osteoarthritis and SASD bursitis (MPG 1782 kb)

Supplementary material 3: Video 2 Rheumatoid arthritis (MPG 1312 kb)

Supplementary material 4: Video 3 Partial supraspinatus tendon tear (MPG 2118 kb)

Supplementary material 5: Video 4 Complete supraspinatus tendon tear (MPG 864 kb)

Supplementary material 6: Video 5 Bursitis as a complication in the reconstruction of the supraspinatus tendon (MPG 664 kb)

Supplementary material 7: Video 6 Calcium-related bursitis (MPG 858 kb)

Supplementary material 8: Video 7 Acute shoulder trauma (MPG 4670 kb)

Supplementary material 9: Video 8 Acute shoulder trauma (MPG 598 kb)

Supplementary material 10: Video 9 Acute shoulder trauma (Hill-Sachs lesion) (MPG 998 kb)

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Draghi, F., Scudeller, L., Draghi, A.G. et al. Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study. J Ultrasound 18, 151–158 (2015). https://doi.org/10.1007/s40477-015-0167-0

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Keywords

  • Ultrasound
  • Subacromion-subdeltoid bursa
  • Bursal inflammation
  • Shoulder pain