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Subdeltoid bursitis, acute
Acute subdeltoid bursitis
This is a disorder we should never miss ; both history and clinical examination are most typical.
Subdeltoid bursitis, acute (2)
a) Typical history
Spontaneous onset without an apparent reason. The disorder occurs at any age from adolescence onwards. It becomes much rarer after the age of 65 y. (The youngest patient seen so far, was a 17 year old female).
The entire bursa (subdeltoid and subacromial part) is inflamed. The patient has severe arm pain in the C5-dermatome for 7-10 days with a spontaneous recovery after 4 weeks (in total about 6 weeks).
Onset is spread over three days. Spontaneous onset of slight arm pain, becoming much worse the next day with difficulty in moving the arm. On the third day, the patient can hardly elevate the arm (maybe 30°) because of extreme pain. If there is a recurrence, it is to be expected during the first 5 years.
b) Image
We find a clear non-capsular pattern. Abduction is most limited, not lateral rotation. Of course, the rotations are also painful and limited, and perhaps the resisted abduction/lateral rotation could also be painful. Swelling in the deltoid area is possible.
c) Treatment
If the patient is seen within the first week, a strong analgesic injection followed by two infiltrations of triamcinolone in the entire bursa (subdeltoid and subacromial parts) is indicated.
The day after the injections, the patient is mostly 80 % better. If needed, another small infiltration is given a couple of days later.
If the patient is evaluated after the first week, analgesic drugs and a figure-of-eight
bandage for seven nights are helpful during the phase of the spontaneous cure.
Remark : if there is calcification, then the spontaneous cure occurs more rapidly in 4 weeks (instead of 6 weeks). But, more recurrences are to be expected.
A haemorraghic bursitis is more common in elderly patients, with a spontaneous onset or following a tendinous rupture.
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