BURSITIS SUBACROMIAL SUBDELTOIDEA PDF

It does not communicate directly with the glenohumeral joint. The bursa has a widespread network of sensory receptors suggesting that the bursa plays a significant role in pain perception as well as neuromuscular coordination and proprioception. Supraspinatus tendon tear. In a normal shoulder, the SASD bursa does not communicate with the glenohumeral joint, as it lies above the supraspinatus tendon. In the event of a full-thickness tear of the tendon, the bursa may now communicate with the glenohumeral joint and fluid accumulation may develop.

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It does not communicate directly with the glenohumeral joint. The bursa has a widespread network of sensory receptors suggesting that the bursa plays a significant role in pain perception as well as neuromuscular coordination and proprioception. Supraspinatus tendon tear. In a normal shoulder, the SASD bursa does not communicate with the glenohumeral joint, as it lies above the supraspinatus tendon. In the event of a full-thickness tear of the tendon, the bursa may now communicate with the glenohumeral joint and fluid accumulation may develop.

Supraspinatus calcific tendinopathy. In this pathology, calcium may leak into the SASD bursa. This type of bursitis is more common in women, and the pain can severe and disabling. Direct acute trauma to the bursa. Can include a fall onto the elbow, which drives the humeral head up into the bursa and overlying acromion process.

In severe trauma the SASD bursa may rupture. Chronic trauma. Repeated impingement of the bursa due to altered glenohumeral centring and dysfunctional scapular mechanics in the overhead athlete may be problematic to overhead athletes such as swimmers, tennis players, gymnasts, weight lifters and throwers, as their exposure to potentially impinging positions is relatively high.

Signs and symptoms The typical symptoms experienced in SASB include: Insidious onset of shoulder pain over a few weeks to months, or pain that is acute in nature following a trauma that compresses the humeral head into the acromion with loaded exercises eg weighted dips. Pain is usually felt in the anterior and lateral part of the shoulder, but may radiate down to the mid-humerus level.

It may be painful to palpate around the top of the humeral head. Pain in bed when sleeping on the shoulder or sleeping with the arm overhead and when severe will wake the patient at night. A loss of shoulder internal rotation movements — eg putting the hand behind the back. This test is believed to compress not only the bursa, but the rotator cuff tendons and long head of bicep under the acromion process. The assessor braces the arm in passive forward flexion with one arm and then passively internally rotates the shoulder with the other hand.

Pain under the acromion process is positive as a clinical diagnosis of impingement due to the greater tuberosity rotating into the acromion process. Treatment Conservative In an acute setting of SASD bursitis, the athlete may need a short period of load management and activity modification to allow the inflamed bursa to recover. For example; The high level swimmer may need to reduce pool mileage for a day period.

The elite tennis player may need to limit overhead serving and power in serving. The Olympic weightlifter may need to limit overhead lifts for a period of time such as avoiding jerks and snatches. Cross-fit athletes may need to avoid overhead loading for short period — eg avoiding handstand positions, overhead squats, instead performing workouts that keep the arm below 90 degrees abduction for a period of time. Kinematics The clinician needs to understand the kinematics of the glenohumeral joint to fully appreciate the consequences of how a decrease in subacromial space can adversely affect the SASD bursa and what factors lead to a decrease in space between the acromion and the humeral head.

In the normal healthy shoulder, the space between the humeral head to the coracoacromial arch is This space may be reduced due to anatomical factors such as the shape of the acromion process and thickening of the coracoacromial ligament. Movement disorders that may affect this space and narrow the space have the potential to chronically impinge the subacromial tissues.

In summary, a few significant movement faults to consider are as follows: Excessive superior humeral head translation— This is due to excessive deltoid contraction during abduction and is more evident if the arm is abducted in internal rotation as the deltoid has a greater pull and the subacromial space naturally diminishes due to the greater tuberosity rotating closer the acromion process.

Interventions to minimise this upward translation are to choose abduction exercises in that involve external rotation. Interventions to minimise this upward and anterior translation include stretches for the posterior shoulder capsule.

Poor depression and centring of the humeral head in abduction— This occurs due to poor rotator cuff activation, particularly the supraspinatus and subscapularis. Interventions for this include isolated activation exercises for the supraspinatus and subscapularis.

Scapulothoracic muscle imbalances and ribcage mobility will both enable this scapular movement. Interventions to improve these individual functions include: Improve upward rotation— Reduce hypertonicity and improve myofascial length of the downward rotators such as pectoralis minor, levator scapulae and rhomboids. Improve activation of the upward rotators such as serratus anterior and lower trapezius. Improve scapular external rotation— Reduce hypertonicity and improve myofascial length of the internal rotators such as the pectoralis minor and improve activation of the external rotators such as the serratus anterior.

Improve elevation of the scapular— Reduce hypertonicity and improve myofascial length of the depressors such as the pectoralis minor and the latissimus dorsi. Improve activation of the elevators such as the upper trapezius. Improve posterior tilt of the scapular— Reduce hypertonicity and improve myofascial length of the anterior tilt muscles such as the pectoralis minor and improve activation of the posterior tilt muscles such as the serratus anterior.

Injection Injections into the SASD bursa using delayed-release corticosteroids and local anaesthetic lidocaine are reasonably common and may have a rapid and significant effect on improving pain and function. Due to the confined space of the bursa, a local anaesthetic will only work in relieving pain in the bursa. If the patient notices almost complete resolution of shoulder pain following injection, then the clinician has more concrete evidence the pain is emanating from the bursa.

References Br J Sports Med. Philadelphia: Mosby Elsevier.

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Bursitis Subacromial – Que es, causas, síntomas, tratamiento

Pain along the front and side of the shoulder is the most common symptom and may cause weakness and stiffness. The onset of pain may be sudden or gradual and may or may not be related to trauma. Night time pain, especially sleeping on the affected shoulder, is often reported. Localized redness or swelling are less common and suggest an infected subacromial bursa. Individuals affected by subacromial bursitis commonly present with concomitant shoulder problems such as arthritis , rotator cuff tendinitis , rotator cuff tears , and cervical radiculopathy pinched nerve in neck. Impingement may be brought on by sports activities, such as overhead throwing sports and swimming, or overhead work such as painting, carpentry, or plumbing.

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