|
|
|
|
Acute subdeltoid bursitis in the shoulder
Acute subdeltoid bursitis ?
Very typical history: a patient who,without any injury, in the course of two or three days loses almost all capacity to abduct his arm, is almost certainly suffering from acute subdeltoid bursitis.
There is no limit of age, but it is very uncommon after 65.
In acute subdeltoid bursitis the non capsular pattern is clinically obvious : abduction is severily limited and painful, both rotations are less limited.
Palpation for tenderness is usually very obvious. The subdeltoid part of the bursa, as a whole, is very tender.
Painful arc cannot be elicited because of too much pain limiting the abduction.
Acute subdeltoid bursitis - therapy
Therapy
First week: strong analgesic, the entire area of the bursa affected is infiltrated (the subdeltoid and the subacromial part), a drop at each point, with 5 ml of triamcinolone suspension. Few days later, if any aching persists, another 2 ml of the suspension may be needed.
A sling should be worn for a week or two by day. A figure-of-eight bandage round the thorax is suggested for the night. Antinflammatory therapy may be continued for a week.
Chronic subdeltoid bursitis
Chronic or localized subdeltoid bursitis ?
The main symptom is a painful arc with end range pain on passive movements (elevation and rotations): normally, none of the resisted movements usually hurt, although it is possible that resisted abduction or lateral rotation are painful, due to an extra compression on the bursa. In that case, repeat the resisted tests in lying and mostly then they will become negative.
So, if a resisted test in standing is positive, but in lying it become negative, we don't think of a contractile lesion anymore, but we think of compression on an inert structure, in that case the subdeltoid bursa.
Every diagnosis of localized subdeltoid bursitis needs to be confirmed by local anestesia.
The diagnostic injection also provides the treatment. If it fails,triamcinolone suspension is used.
|
|
|
 |
|
|
Discover more orthopaedic medicine items |
|
| |
|
|
|
|
|
|
 |
|
