Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of four rotator cuff tendons) of the coraco-acromial ligament, acromion, coracoid acromial arch) and from the inner surface of the deltoid muscle. The subacromial bursa helps the tendering movement of supraspinatus rotator cuff in activities such as overhead work.
Musculoskeletal complaints are one of the most common reasons for primary care office visits, and rotator cuff disorders are the most common source of shoulder pain.
Primary inflammation of the subacromial bursa is relatively rare and may arise from autoimmune inflammatory conditions such as rheumatoid arthritis; crystal deposition disorders such as uric acid or pseudogout; calcified fungal body, and infection. More commonly, subakromial bursitis arises as a result of complex factors, allegedly causing shoulder throwing symptoms. These factors are broadly classified as intrinsic (intratendinous) or extrinsic (extratendinous). They are subdivided into primary or secondary causes of impingement. Secondary causes are considered part of other processes such as shoulder instability or nerve injury.
In 1983 Neer described the three stages of the impingement syndrome. He noted that "the symptoms and physical signs of the three stages of impingement are almost identical, including the 'sign of impingement'..., arc of pain, crepitations, and weaknesses." Neer Classification does not distinguish between partial thickness and full rotator cuff tears thickness in stage III. This led to some controversy about the ability of a physical examination test to accurately diagnose bursitis, outlet, throwing with or without a rotator cuff tear and an impingement with a partial and complete tear.
In 2005, Park et al. published their findings which concluded that a combination of clinical tests is more useful than a single physical examination test. For the diagnosis of impingement, the best combination of tests is "every level of positive Hawkins-Kennedy test, painful positive bow marks, and weakness in external rotation with the arm on the side," to diagnose full thickness. rotator cuff tear, best test combination, when all three are positive, are painful arcs, drop-arm marks, and weaknesses in external rotation.
Video Subacromial bursitis
Signs and symptoms
Subacromial bursitis often presents with a symptom constellation called an outlet syndrome. Pain along the front and side of the shoulder is the most common symptom and can cause weakness and stiffness. If pain is lost and a permanent weakness other causes should be evaluated such as a rotator cuff or a neurological problem arising from the neck or suprascapular nerve trap. The onset of pain may be sudden or gradual and may or may not be associated with trauma. Pain at night, especially sleeping on the affected shoulder, is often reported. Redness or localized swelling is less common and indicates an infected subacromic bursa. Individuals affected by subacromial bursitis commonly present with joint shoulder problems such as arthritis, rotator cuff tendinitis, rotator cuff tears, and cervical radiculopathy (nerves caught in the neck).
Impingement can be caused by sports activities, such as ups and downs swimming, or above work such as painting, carpentry, or piping. Activities that involve recurring overhead activity, or directly in front, can cause shoulder pain. Direct pressure toward the shoulder, like leaning on the elbow, can increase the pain.
Maps Subacromial bursitis
Pathophysiology
The literature on bursitis pathophysiology describes inflammation as the main cause of symptoms. Inflammatory bursitis is usually the result of repeated injuries to the bursa. In subacromial exchanges, this generally occurs due to microtrauma to adjacent structures, especially the supraspinatus tendons. The inflammatory process causes the synovial cells to multiply, increasing the formation of collagen and the production of fluids in the bursa and reducing the outer layer of lubrication (Ishii et al., 1997).
Less frequent subacromial bursitis causes include hemorrhagic conditions, crystalline precipitation and infection.
Many causes have been proposed in the medical literature for subacromial abuse syndrome. The exchange facilitates the rotator cuff movement under the arch, any interference in the subacromic structure may lead to impingement. These factors can be broadly classified as intrinsic as tendon degeneration, muscle rotator cuff weakness and overuse. Extrinsic factors include bone spurs from acromion or AC joint, shoulder instability and neurological problems arising outside the shoulders.
Diagnosis
It is often difficult to distinguish between pain caused by bursitis or caused by a rotator cuff injury as both exhibit the same pattern of pain on the front or side of the shoulder (Hartley, 1990). Subacromial bursitis can be painful with kidnappings due to stripping of the bursa as a deltoid contract (Buschbacher & Braddom, 1994). If the therapist performs a treatment direction test and gently implements joint or caudal glide traction during abduction (MWM), painful bow can be reduced if the problem is bursis or capsulitis adhesive (as this potentially increases subacromial space).
The following clinical tests, if positive, may indicate bursitis:
- Patients actively kidnap arms and painful arcs occur between 80 Â ° and 120 Â °. This is due to the compression of the supraspinatus tendon or the subakromial bursa between the anterior acromial arch and the humeral head. When lowering from full kidnapping there is often a painful "catch" in the midrange. If the patient can achieve adequate muscle relaxation, passive movements tend to be less painful (Starr & Harbhajan, 2001).
- The patient performs an isometric flexion contraction against therapeutic resistance (Speed ​​Test). When therapeutic resistance is eliminated, sudden sudden outcome and latent pain show positive tests for bursitis (Buschbacher & Braddom, 1994).
- Neer Sign: If the pain occurs during the forward elevation of the arm rotated internally above 90 °. This will identify the rotator cuff impingement but also be sensitive to subacromial bursitis (Starr & Harbhajan, 2001).
Irritation or sub-subscapular nerve trapping, which supplies the subscapularis and the main muscle of teres, will produce protective muscles in the shoulder that will limit the motion to external rotation, kidnapping, or flexion. These tests will assist in diagnosing bursitis over other conditions. The diagnosis of impingement syndrome should be seen carefully in people less than forty years, since such people may have subtle glenohumeral instability.
Imaging
X-rays can help visualize bone spurs, acromial anatomy and arthritis. Furthermore, calcification in subacromial space and rotator cuff may be revealed. Osteoarthritis of the acromioclavicular joint (AC) can coexist and is usually shown on radiographs.
Imagination MRI can reveal fluid accumulation in the bursa and assess adjacent structures. In chronic cases caused by tendinosis throwing and tears in the rotator cuff can be revealed. In the US, an abnormal exchange may indicate (1) fluid distension, (2) synovial proliferation, and/or (3) thickening of the bursal wall. However, the magnitude of the pathological findings is not correlated with the magnitude of symptoms.
Special considerations
In patients with bursitis who have rheumatoid arthritis, short-term fixes are not taken as a sign of resolution and may require long-term treatment to ensure recurrence is minimized. Shoulder joint contractures are also found to be at a higher incidence in people with type 2 diabetes, which can lead to frozen shoulder (Donatelli, 2004).
Treatment
Many non-operative treatments have been advocated, including rest; oral administration of non-steroidal anti-inflammatory drugs; physical therapy; chiropractic; and local modalities such as cryotherapy, ultrasound, electromagnetic radiation, and subacromial corticosteroid injection.
Bursitis shoulders rarely require surgical intervention and generally provide a positive response to conservative treatment. Surgery is reserved for patients who fail to respond to non-operative measures. Minimally invasive surgical procedures such as arthroscopic removal in the bursa allow for direct inspection of the shoulder structure and provide an opportunity for removal of bone spurs and improvement of cuff rotator spikes that may be found.
Initial/start
Middle/intermittent
Delay/return to function
Prognosis
In 1997 Morrison et al. published a study that examined the case of 616 patients (636 shoulders) with an outpatient syndrome (painful arc of motion) to assess non-surgical treatment outcomes. Efforts were made to exclude patients suspected of having additional shoulder conditions such as, colorful tears on rotator cuff, degenerative arthritis of acromioclavicular joints, glenohumeral joint instability, or capsulitis adhesives. All patients were administered with anti-inflammatory drugs and specially-supervised physical therapy regimens. The patients were followed up from six months to over six years. They found that 67% (413 patients) of the patients improved, while 28% did not improve and went to surgical treatment. 5% did not improve and refused further treatment.
Of the 413 patients who improved, 74 had symptomatic relapse during the observation period and their symptoms responded to rest or after restarting the exercise program.
Morrison studies show that the results of overlapping symptoms vary with patient characteristics. Younger patients (20 years or less) and patients between 41 and 60 years, fared better than those in the 21 to 40 age group. This may be related to the peak of job incidences, job requirements, activities related to sports and hobbies, which may place greater demands on the shoulders. However, patients over the age of sixty had "the worst outcome". It is known that the rotator cuff and adjacent structures undergo degenerative changes with aging.
References
Anderson, D., M, (2000), Kamus Medis Illustrated Dorland , edisi 29, W.B. Saunders Company, Kanada, 965-967.
Buschbacher, R., M, Braddom, R., L. (1994). Sports & amp; rehabilitation: A special sporting approach . Hanley and Belfus Inc., Philadelphia.
Hartley, A. (1990). Practical shared assessment: A sports medicine guide, St. Louis, Sydney.
External links
Source of the article : Wikipedia
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