Subdeltoid bursitis : acute or chronic ?

Subdeltoid bursitis in the shoulder : acute or chronic ?


Acute subdeltoid bursitis ?

The patient describes a very typical history: mostly ,without any injury, in the course of two or three days he loses almost all capacity to abduct his arm and suffers from constant pain within the C5-dermatome.  The patient is mostly younger than 65 years.

In an acute subdeltoid bursitis the non capsular pattern is clinically obvious : active and passive abduction is severily limited and painful, both rotations are less limited, but also quite painful.
Palpation for tenderness is usually very obvious. The palpable subdeltoid part of the bursa, as a whole, is very tender.
A painful arc cannot be elicited because of too much pain limiting the abduction.

Chronic subdeltoid bursitis ?

A chronic subdeltoid bursitis is not an acute bursitis which became chronic.

We are talking about a different pathology : in the acute bursitis there is an inflammation of the complete bursa where as in the chronic one there is more an irritation of some part of the bursa : the palpable subdeltoid or the non-palpable subacromial part.

The main symptom is a clear painful arc with end range pain on passive movements (elevation and rotations): mostly, none of the resisted movements usually hurt, although it is possible that resisted abduction and/or lateral rotation are painful, due to an extra compression on the bursa. 

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